Provider Demographics
NPI:1942084900
Name:ST DENTAL PLLC
Entity Type:Organization
Organization Name:ST DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SABA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DR DMD
Authorized Official - Phone:817-899-5397
Mailing Address - Street 1:1503 ROYAL LANE
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:817-899-5397
Mailing Address - Fax:469-966-4909
Practice Address - Street 1:1012 SOUTH CROWLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036
Practice Address - Country:US
Practice Address - Phone:972-772-3402
Practice Address - Fax:469-966-4909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty