Provider Demographics
NPI:1629759873
Name:RST SOUL DENTAL PLLC
Entity Type:Organization
Organization Name:RST SOUL DENTAL PLLC
Other - Org Name:SOUL FAMILY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-445-8588
Mailing Address - Street 1:5018 BRAESHEATHER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4205
Mailing Address - Country:US
Mailing Address - Phone:479-445-8588
Mailing Address - Fax:
Practice Address - Street 1:10350 S POST OAK RD STE H
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3319
Practice Address - Country:US
Practice Address - Phone:713-551-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty