Provider Demographics
NPI:1386187904
Name:CSTN PLLC
Entity Type:Organization
Organization Name:CSTN PLLC
Other - Org Name:COMET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHANH
Authorized Official - Middle Name:DUY
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, DDS
Authorized Official - Phone:832-466-2022
Mailing Address - Street 1:12906 RIDGE BANK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-6853
Mailing Address - Country:US
Mailing Address - Phone:832-466-2022
Mailing Address - Fax:
Practice Address - Street 1:12586 WESTHEIMER RD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5866
Practice Address - Country:US
Practice Address - Phone:832-466-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty