Provider Demographics
NPI:1811147986
Name:LONE STAR DENTISTRY CLINIC PC
Entity type:Organization
Organization Name:LONE STAR DENTISTRY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAO
Authorized Official - Middle Name:TRAN
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-941-4455
Mailing Address - Street 1:312 S BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-2614
Mailing Address - Country:US
Mailing Address - Phone:214-941-4455
Mailing Address - Fax:214-941-4464
Practice Address - Street 1:312 S BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-2614
Practice Address - Country:US
Practice Address - Phone:214-941-4455
Practice Address - Fax:214-941-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty