Provider Demographics
NPI:1588755631
Name:TEXAS LONE STAR DENTAL CENTER PA
Entity type:Organization
Organization Name:TEXAS LONE STAR DENTAL CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-858-7660
Mailing Address - Street 1:711 HIGHWAY 290 WEST
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620
Mailing Address - Country:US
Mailing Address - Phone:512-858-7660
Mailing Address - Fax:512-858-7316
Practice Address - Street 1:711 HIGHWAY 290 WEST
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620
Practice Address - Country:US
Practice Address - Phone:512-858-7660
Practice Address - Fax:512-858-7316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12598OtherBCBS