Forney Mirror Lake Dentistry Pllc

NPI #1730676735 in Forney, Texas

Provider Information

NPI Number: 1730676735
Entity Type: Organization
Organization Name: Forney Mirror Lake Dentistry Pllc
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Apr 16, 2018
Last Updated: Apr 16, 2018

Practice Location

Address: 845 N. FM 548
Address 2: SUITE 150
City: Forney
State: Texas
ZIP Code: 75126
Phone: (972) 200-1190

Authorized Official

Name: JUSTIN HUMPHRIES
Title: DIRECTOR OF OPERATIONS
Phone: (972) 200-1190

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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