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Organization
HEATH MIRROR LAKE DENTISTRY PLLC
Active
Organization
HEATH MIRROR LAKE DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN HUMPHRIES (DIRECTOR OF OPERATIONS)
(972) 287-5513
Entity
Organization
Contact information
Practice address
4225 RIDGE RD, HEATH, TX 75032-5833
(972) 287-5513
Mailing address
605 AVALON DR, SEAGOVILLE, TX 75159-3034
(972) 287-5513
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
29699
TX
Other
Enumeration date
04/16/2018
Last updated
04/16/2018
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