Provider Demographics
NPI:1154658540
Name:STAR SMILE DENTAL AND ORTHODONTICS
Entity Type:Organization
Organization Name:STAR SMILE DENTAL AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IOANA
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:PORFIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:312-451-5976
Mailing Address - Street 1:520 E VINE ST
Mailing Address - Street 2:PO BOX 2075
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2300
Mailing Address - Country:US
Mailing Address - Phone:214-377-6436
Mailing Address - Fax:214-377-6436
Practice Address - Street 1:2475 S COCKRELL HILL RD STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8103
Practice Address - Country:US
Practice Address - Phone:214-377-6436
Practice Address - Fax:214-377-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty