Provider Demographics
NPI:1033370721
Name:TEXAS STAR DENTAL CENTER, P.A.
Entity Type:Organization
Organization Name:TEXAS STAR DENTAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BSOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-744-5402
Mailing Address - Street 1:8111 MAINLAND DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3748
Mailing Address - Country:US
Mailing Address - Phone:210-523-2700
Mailing Address - Fax:210-523-2701
Practice Address - Street 1:8111 MAINLAND DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3748
Practice Address - Country:US
Practice Address - Phone:210-523-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty