Organization
HEARTLAND MIRROR LAKE DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN HUMPHRIES (DIRECTOR OF OPERATIONS)
(972) 200-4311
Entity
Organization
Contact information
Practice address
2049 SUNNYBROOK DR, HEARTLAND, TX 75126-1270
(972) 200-4311
Mailing address
2049 SUNNYBROOK DR, HEARTLAND, TX 75126-1270
(972) 200-4311
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
29699
TX
Other
Enumeration date
04/13/2018
Last updated
04/13/2018
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