Forney Mirror Lake Dentistry PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

29699 Issued in TX

Legal business name

FORNEY MIRROR LAKE DENTISTRY PLLC

Practice address

845 N. FM 548
Suite 150
Forney, TX 75126

Phone

(972) 200-1190

NPI assigned

Apr 16, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin Humphries

Title

Director of Operations

Phone

(972) 200-1190

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Natalie Mouzon Haseloff, DMD

  • General Practice Dentistry
  • Lubbock, TX
  • NPI 1710473244
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1730676735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N. FM 548",
            "address_2": "SUITE 150",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "75126",
            "telephone_number": "972-200-1190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N. FM 548",
            "address_2": "SUITE 150",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "75126",
            "telephone_number": "972-200-1190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORNEY MIRROR LAKE DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-16",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "HUMPHRIES",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "972-200-1190"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TX",
            "license": "29699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Forney Family Dental PLLC
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• Forney Health Pharmacy LLC
• Forney Isd
• Forney Medical Transportation LLC
• Forney Modern Dentistry and Orthodontics
• Forney Pediatric & Medical Clinic P.a.
• Forney Sleep Lab, LLP
• Forney Tooth Dental Management, LLC
• Fortitude Counseling, LLC

• Dental Clinic/Center in Forney, TX
• Providers in Forney, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; 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.