Healthcare Provider Details

I. General information

NPI: 1689926636
Provider Name (Legal Business Name): STELLAR IMPLANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 TURTLE CREEK BLVD STE 275
DALLAS TX
75219-6247
US

IV. Provider business mailing address

2515 MCKINNEY AVE STE 940
DALLAS TX
75201-1908
US

V. Phone/Fax

Practice location:
  • Phone: 214-932-3399
  • Fax:
Mailing address:
  • Phone: 972-747-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20960
License Number StateTX

VIII. Authorized Official

Name: DR. SON TRAN
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 214-747-1400