Provider Demographics
NPI:1659194793
Name:STAR SMILES PLLC
Entity type:Organization
Organization Name:STAR SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VAMSHIDER
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KYATAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-417-1161
Mailing Address - Street 1:26919 US HIGHWAY 380 E
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7804
Mailing Address - Country:US
Mailing Address - Phone:940-213-3752
Mailing Address - Fax:940-213-3763
Practice Address - Street 1:26919 US HIGHWAY 380 E
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-7804
Practice Address - Country:US
Practice Address - Phone:940-213-3752
Practice Address - Fax:940-213-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty