Provider Demographics
NPI:1093137192
Name:LONE STAR DENTAL AND BRACES DALLAS PLLC
Entity Type:Organization
Organization Name:LONE STAR DENTAL AND BRACES DALLAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-331-4867
Mailing Address - Street 1:2509 S HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1623
Mailing Address - Country:US
Mailing Address - Phone:214-331-4867
Mailing Address - Fax:
Practice Address - Street 1:2509 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-1623
Practice Address - Country:US
Practice Address - Phone:214-331-4867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty