Healthcare Provider Details

I. General information

NPI: 1275296717
Provider Name (Legal Business Name): LONE STAR DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 WELLS BRANCH PKWY STE 700
AUSTIN TX
78728-6619
US

IV. Provider business mailing address

3407 WELLS BRANCH PKWY STE 700
AUSTIN TX
78728-6619
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-7677
  • Fax:
Mailing address:
  • Phone: 512-244-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HARISH GOGINENI
Title or Position: CHIEF DENTAL OFFICER
Credential: DDS
Phone: 732-986-4338