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General NPI Number Information
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NPI Number | 1508165200
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Entity Type | Organization
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Legal Business Name | TEXAS STAR DENTAL
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 142 VINTAGE PARK BLVD STE E
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City | HOUSTON
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State | TX
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Zip | 77070-3997
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Country | US
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Telephone | 281-374-0611
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Fax |
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Provider Business Mailing Address
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Address Line | 142 VINTAGE PARK BLVD STE E
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City | HOUSTON
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State | TX
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Zip | 77070-3997
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Country | US
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Telephone | 281-374-0611
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAUREN R AUSTIN
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Credential | DDS
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Telephone | 281-374-0611
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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 | 24731
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License Number State | TX
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