Organization
TEXAS WISDOM TEETH SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A BENAGE DDS (GENERAL DENTIST)
(972) 786-4307
Entity
Organization
Contact information
Practice address
8409 W CLEBURNE RD, FORT WORTH, TX 76123-1421
(214) 814-1057
Mailing address
129 CIRCLE CLUB LN, LONGVIEW, TX 75602-4866
(903) 445-2433
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
11/04/2020
Last updated
11/09/2020
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