TEXAS WISDOM TEETH SPECIALISTS (NPI# 1134720337) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134720337 |
| Entity Type | Organization |
| Organization Name | TEXAS WISDOM TEETH SPECIALISTS |
| Practice Address |
8409 W Cleburne Rd Fort Worth TX 76123-1421 |
| Mailing Address |
129 Circle Club Ln Longview TX 75602-4866 |
| Practice Telephone | 2148141057 |
| Mailing Telephone | 9034452433 |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2020-11-09 |
| Authorized Official Name | DR. MARK A BENAGE (GENERAL DENTIST) |
| Authorized Official Telephone | 9727864307 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Street Address |
8409 W CLEBURNE RD |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76123-1421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205440146 | Ismile Dental At The Chisolm Trail Pllc | Dentist | 5513 Sycamore School Rd, Fort Worth, TX 76123 | 2020-09-08 |
| 1558916361 | Nimu Pllc | Dentist | 5325 Mcpherson Blvd, Suite 120, Fort Worth, TX 76123 | 2019-08-08 |
| 1306361431 | Kelley Phillips | Counselor | 5013 Pallas Court, Fort Worth, TX 76123 | 2017-08-09 |
| 1396280756 | Chisholm Trail Emergency Center | Clinic/Center | 5500 Sycamore School Rd., Ste. 150, Fort Worth, TX 76123 | 2016-12-21 |
| 1457801391 | Point of Grace Home Health | Registered Nurse | 2533 Mill Spring Pass, Fort, TX 76123 | 2016-10-04 |
| 1992253306 | Jason Bowers | Specialist/Technologist, Other | 5316 Quail Feather Dr, Fort Worth, TX 76123 | 2016-09-14 |
| 1831546944 | Kalima Charway | Psychologist | 4532 Endercrest Lane, Fort Worth, TX 76123 | 2016-05-18 |
| 1033551577 | Michael Rose | Specialist | 4924 Belladonna Dr, Fort Worth, TX 76123 | 2013-07-25 |
| 1265871768 | Anna Uppal | Dentist | 100 Wolfe Nursery Street, 180, Stephenville, TX 76123 | 2013-06-18 |
| 1366880627 | Mesa Springs, LLC | Psychiatric Hospital | 5560 Mesa Springs Drive, Fort Worth, TX 76123 | 2013-06-10 |
| Find all providers in zip 76123 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699155507 | Implants and Oral Surgery, PC | Dentist | 7217 Hawkins View Dr Ste 200, Fort Worth, TX 76132-3928 | 2015-06-05 |
| 1386058584 | Keith Sonneveld | Dentist | 4421 Oak Park Ln Ste 101, Fort Worth, TX 76109-9541 | 2014-06-16 |
| 1598968190 | Herman Kao | Dentist | 1625 Saint Louis Ave., Fort Worth, TX 76104 | 2007-06-09 |
| 1215130810 | Fayette Creed Williams | Dentist | 1625 Saint Louis Avenue, House Staff & Gme, Fort Worth, TX 76104 | 2007-06-09 |
| 1235353301 | Robert Peak | Dentist | 900 Jerome St, Suite 140, Fort Worth, TX 76104-3945 | 2007-04-12 |
| 1972614071 | Spielman Peak Lois & Humes Dds Ms Inc. | Dentist | 7217 Hawkins View Dr, Suite 200, Fort Worth, TX 76132-3927 | 2006-08-31 |
| 1225070030 | Gregory Blaine Scheideman | Dentist | 4300 Oak Park Ln, Fort Worth, TX 76109-1512 | 2006-06-13 |
| 1508805516 | Joseph Carl Cecere | Dentist | 2501 Ridgmar Plz, Suite 108, Fort Worth, TX 76116-2689 | 2006-06-05 |
| 1538156658 | Max Gregory Neill | Dentist | 4421 Oak Park Ln, Ste 101, Fort Worth, TX 76109-9541 | 2005-10-04 |
| 1356334502 | David Edward Parmer | Dentist | 9415 N Beach St, Fort Worth, TX 76244-9059 | 2005-08-23 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76123 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.