Provider Demographics
NPI:1215299169
Name:STAR DENTIST PLLC
Entity type:Organization
Organization Name:STAR DENTIST PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:GORAVANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-640-2481
Mailing Address - Street 1:13447 I-10 EAST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5901
Mailing Address - Country:US
Mailing Address - Phone:832-767-5614
Mailing Address - Fax:832-767-5646
Practice Address - Street 1:13447 I-10 EAST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5901
Practice Address - Country:US
Practice Address - Phone:832-767-5614
Practice Address - Fax:832-767-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty