Healthcare Provider Details

I. General information

NPI: 1700773801
Provider Name (Legal Business Name): STARRANCHBRACES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20808 N STATE HIGHWAY 130 STE 220
HUTTO TX
78634-2738
US

IV. Provider business mailing address

1700 W PARMER LN STE 250
AUSTIN TX
78727-4609
US

V. Phone/Fax

Practice location:
  • Phone: 512-351-8362
  • Fax:
Mailing address:
  • Phone: 512-351-8362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIRALI TAHBAZ
Title or Position: ORTHODONTIST/MANAGER
Credential: DDS
Phone: 512-351-8362