Provider Demographics
NPI:1477883858
Name:FIVE STAR DENTAL SERVICES
Entity Type:Organization
Organization Name:FIVE STAR DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-484-2442
Mailing Address - Street 1:2843 HOPYARD RD
Mailing Address - Street 2:#172
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5241
Mailing Address - Country:US
Mailing Address - Phone:925-484-2442
Mailing Address - Fax:
Practice Address - Street 1:2843 HOPYARD RD
Practice Address - Street 2:#172
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5241
Practice Address - Country:US
Practice Address - Phone:925-484-2442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty