Provider Demographics
NPI:1508995598
Name:STAR BRITE DENTAL, HAI Q. XA D.M.D. PROF. CORP.
Entity Type:Organization
Organization Name:STAR BRITE DENTAL, HAI Q. XA D.M.D. PROF. CORP.
Other - Org Name:STAR BRITE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAI
Authorized Official - Middle Name:Q
Authorized Official - Last Name:XA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-456-5100
Mailing Address - Street 1:560 MARKS ST STE B
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8602
Mailing Address - Country:US
Mailing Address - Phone:702-456-5100
Mailing Address - Fax:702-456-5102
Practice Address - Street 1:560 MARKS ST STE B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8602
Practice Address - Country:US
Practice Address - Phone:702-456-5100
Practice Address - Fax:702-456-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3780261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV71048OtherCULINARY
NV1392912OtherUNITED CONCORDIA