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General NPI Number Information
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NPI Number | 1285924100
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Entity Type | Organization
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Legal Business Name | RED STAR DENTAL
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 202 ST.CLAIR CIRLE APT K
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City | YORKTOWN
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State | VA
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Zip | 23693
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Country | US
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Telephone | 757-223-5989
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Fax |
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Provider Business Mailing Address
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Address Line | 14460 HILLCROFT ST STE 102
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City | HOUSTON
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State | TX
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Zip | 77085-1505
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Country | US
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Telephone | 321-525-9357
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. HARRY M JOSEPH
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Credential | DDS
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Telephone | 321-525-9357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25919
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License Number State | TX
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