MEDICARE: DR BEN DEHESHI ORTHOPEDICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1992263628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BEN DEHESHI ORTHOPEDICS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 300, STATE ST #92845
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76104
Country	:	US
Telephone Number	:	817-322-7867
Fax Number	:	817-322-7861

Provider Business Practice Location Address
First Line	:	3412 N TARRANT PKWY STE 520
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8643
Country	:	US
Telephone Number	:	817-322-7867
Fax Number	:	817-322-7861

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN DEHESHI
Credential	:	MD
Telephone Number	:	817-807-3511

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	05/06/2026

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