Provider Demographics
NPI:1275296717
Name:LONE STAR DENTAL CARE PLLC
Entity Type:Organization
Organization Name:LONE STAR DENTAL CARE PLLC
Other - Org Name:ADVANCED SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DENTAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGINENI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-986-4338
Mailing Address - Street 1:3407 WELLS BRANCH PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6619
Mailing Address - Country:US
Mailing Address - Phone:512-244-7677
Mailing Address - Fax:
Practice Address - Street 1:3407 WELLS BRANCH PKWY STE 700
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6619
Practice Address - Country:US
Practice Address - Phone:512-244-7677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty