Organization
TWTSA, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL WADE BENAGE (OWNER)
(903) 445-2433
Entity
Organization
Contact information
Practice address
6025 HARRIS PKWY, FORT WORTH, TX 76132-4103
(214) 814-1057
Mailing address
129 CIRCLE CLUB LN, LONGVIEW, TX 75602-4866
(903) 445-2433
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
10/24/2020
Last updated
10/24/2020
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