Organization
DESOTO DIAGNOSTIC IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC S BENNOS MD, V. PRESIDENT (V.P.)
(972) 274-3175
Entity
Organization
Contact information
Practice address
201 N BECKLEY AVE, FLOWER MOUND, TX 75115
(972) 274-3175
(972) 223-0586
Mailing address
201 N BECKLEY AVE, DESOTO, TX 75115
(972) 274-3175
(972) 223-0586
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MDG 7164
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MDG7164
GROUP
—
Enumeration date
07/08/2005
Last updated
08/22/2020
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