Provider Demographics
NPI:1104233675
Name:ADVANCED FOOT SPECIALISTS, PLLC
Entity type:Organization
Organization Name:ADVANCED FOOT SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASSICHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-394-8645
Mailing Address - Street 1:4515 DORSET RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-6301
Mailing Address - Country:US
Mailing Address - Phone:214-394-8645
Mailing Address - Fax:972-774-1777
Practice Address - Street 1:201 E INTERSTATE 30
Practice Address - Street 2:SUITE B
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5402
Practice Address - Country:US
Practice Address - Phone:214-771-3668
Practice Address - Fax:972-774-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty