MEDICARE: LONE STAR DENTAL AND BRACES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	25574	TX

General Provider Information

NPI Number	:	1699069013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR DENTAL AND BRACES, PLLC

Provider Business Mailing Address
First Line	:	2516 NE 28TH ST STE 100
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76106-7577
Country	:	US
Telephone Number	:	817-744-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2516 NE 28TH ST SUITE 100
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76106-7576
Country	:	US
Telephone Number	:	817-744-8440
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. VIJAY PATEL
Credential	:
Telephone Number	:	972-313-5285

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	07/01/2024

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