Provider Demographics
NPI:1366525792
Name:LONE STAR FAMILY DENTAL
Entity type:Organization
Organization Name:LONE STAR FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELVAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-383-2626
Mailing Address - Street 1:431 STACY RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-8741
Mailing Address - Country:US
Mailing Address - Phone:214-383-2626
Mailing Address - Fax:214-383-1826
Practice Address - Street 1:431 STACY RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-8741
Practice Address - Country:US
Practice Address - Phone:214-383-2626
Practice Address - Fax:214-383-1826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty