Provider Demographics
NPI:1205168994
Name:LONE STAR DENTISTRY CLINIC
Entity type:Organization
Organization Name:LONE STAR DENTISTRY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-956-9200
Mailing Address - Street 1:383 HUFFINES PLZ
Mailing Address - Street 2:SUITE 380
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-4674
Mailing Address - Country:US
Mailing Address - Phone:972-956-9200
Mailing Address - Fax:972-956-8200
Practice Address - Street 1:383 HUFFINES PLZ
Practice Address - Street 2:SUITE 380
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-4674
Practice Address - Country:US
Practice Address - Phone:972-956-9200
Practice Address - Fax:972-956-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty