Healthcare Provider Details

I. General information

NPI: 1356255871
Provider Name (Legal Business Name): NORTHSTAR ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 W UNIVERSITY DR STE 60
PROSPER TX
75078-9993
US

IV. Provider business mailing address

4640 LIBERTY DR
PROSPER TX
75078-5173
US

V. Phone/Fax

Practice location:
  • Phone: 202-849-1999
  • Fax:
Mailing address:
  • Phone: 443-956-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID B BONEBREAK
Title or Position: OWNER
Credential: DDS MS
Phone: 443-956-5814