Provider Demographics
NPI:1386187904
Name:CSTN DENTAL PLLC
Entity type:Organization
Organization Name:CSTN DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-878-3353
Mailing Address - Street 1:12586 WESTHEIMER RD, SUITE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077
Mailing Address - Country:US
Mailing Address - Phone:832-288-4365
Mailing Address - Fax:
Practice Address - Street 1:12586 WESTHEIMER RD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5866
Practice Address - Country:US
Practice Address - Phone:832-466-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302991223G0001X
343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty