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General NPI Number Information
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NPI Number | 1215299169
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Entity Type | Organization
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Legal Business Name | STAR DENTIST PLLC
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 05/21/2022
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Provider Practice Location Address
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Address Line | 13447 I-10 EAST
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City | HOUSTON
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State | TX
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Zip | 77015-5901
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Country | US
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Telephone | 832-767-5614
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Fax | 832-767-5646
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Provider Business Mailing Address
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Address Line | 13447 I-10 EAST
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City | HOUSTON
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State | TX
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Zip | 77015-5901
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Country | US
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Telephone | 832-767-5614
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Fax | 832-767-5646
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Authorized Official
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Title or Position | DENTIST
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Name | BABAK GORAVANCHI
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Credential | DDS
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Telephone | 832-640-2481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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