Provider Demographics
NPI:1780639070
Name:LONE STAR ORTHODONTICS, P.A.
Entity type:Organization
Organization Name:LONE STAR ORTHODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HARTSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-278-1111
Mailing Address - Street 1:8900 LONE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-4843
Mailing Address - Country:US
Mailing Address - Phone:512-278-1111
Mailing Address - Fax:
Practice Address - Street 1:7517 CAMERON RD
Practice Address - Street 2:STE #106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-2057
Practice Address - Country:US
Practice Address - Phone:512-278-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1766842-01Medicaid