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General NPI Number Information
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NPI Number | 1326923939
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Entity Type | Organization
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Legal Business Name | HIGHLAND PARK MSO LLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 3001 KNOX ST STE 301
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City | DALLAS
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State | TX
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Zip | 75205-5593
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Country | US
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Telephone | 214-824-8960
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Fax |
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Provider Business Mailing Address
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Address Line | 550 RESERVE ST STE 330
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1599
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Country | US
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Telephone | 817-226-6790
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | RYAN GRAHAM
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Credential |
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Telephone | 310-739-5685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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