# TEXAS WISDOM TEETH SPECIALISTS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134720337
- **Authorized official:** DR. MARK A BENAGE DDS (GENERAL DENTIST)
- **Authorized official phone:** (972) 786-4307

## Contact information

- **Practice address:** 8409 W CLEBURNE RD, FORT WORTH, TX 76123-1421
- **Practice address phone:** (214) 814-1057
- **Mailing address:** 129 CIRCLE CLUB LN, LONGVIEW, TX 75602-4866
- **Mailing address phone:** (903) 445-2433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 11/04/2020
- **Last updated:** 11/09/2020