Provider Demographics
NPI:1619123536
Name:AESTHETIC DENTISTRY, PA
Entity Type:Organization
Organization Name:AESTHETIC DENTISTRY, PA
Other - Org Name:LONE STAR DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-335-7100
Mailing Address - Street 1:4500 HILLCREST RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5418
Mailing Address - Country:US
Mailing Address - Phone:972-335-7100
Mailing Address - Fax:
Practice Address - Street 1:4500 HILLCREST RD
Practice Address - Street 2:SUITE 190
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5418
Practice Address - Country:US
Practice Address - Phone:972-335-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty