Provider Demographics
NPI:1215799598
Name:DENTASTYLE, PLLC
Entity type:Organization
Organization Name:DENTASTYLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-228-3110
Mailing Address - Street 1:2960 INTERSTATE 45 N STE 300
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-7912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 W MONTGOMERY ST STE 300
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-8829
Practice Address - Country:US
Practice Address - Phone:936-228-3110
Practice Address - Fax:936-228-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty