Mark V Wagner DMD PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MARK V WAGNER DMD PLLC

Practice address

2600 Village Pkwy Ste 120
Highland Village, TX 75077-3285

Phone

(469) 444-6500

Fax

(972) 317-0777

NPI assigned

Jul 20, 2020

Organization subpart

No

Name

Dr. Mark Vincent Wagner, DMD

Title

Owner

Phone

(469) 444-6500

• Highland Village Family Dentistry Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 27, 2020.

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598486400000",
    "number": "1396353025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 VILLAGE PKWY STE 120",
            "city": "HIGHLAND VILLAGE",
            "state": "TX",
            "postal_code": "750773285",
            "telephone_number": "469-444-6500",
            "fax_number": "972-317-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 VILLAGE PKWY STE 120",
            "city": "HIGHLAND VILLAGE",
            "state": "TX",
            "postal_code": "750773285",
            "telephone_number": "469-444-6500",
            "fax_number": "972-317-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK V WAGNER DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-20",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-444-6500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Highland Village Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Highland Village Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Macias-McKensey, MS, CCC-SLP
• Brianna Macias
• Elizabeth Mackie
• Michelle Maier, REEGT
• Makeidea
• Brian Martin
• Amber-Lea Michelle Fiedler Martinez, MS, LPC-ASSOCIATE
• Michelle Martz, D.C.
• Julie Joy Mathew, O.D.
• Abraham Mathukutty

• All providers in Highland Village, TX
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.