| NPI | 1396353025 |
|---|---|
| Doing Business As | HIGHLAND VILLAGE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MARK VINCENT WAGNER Owner 469-444-6500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2020-08-27 |