MEDICARE: STELLAR IMPLANTS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	20960	TX

General Provider Information

NPI Number	:	1689926636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STELLAR IMPLANTS, PLLC

Provider Business Mailing Address
First Line	:	2515 MCKINNEY AVE
Second Line	:	STE 940
City	:	DALLAS
State	:	TX
Zip	:	75201-1908
Country	:	US
Telephone Number	:	972-747-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 TURTLE CREEK BLVD
Second Line	:	STE 275
City	:	DALLAS
State	:	TX
Zip	:	75219-6247
Country	:	US
Telephone Number	:	214-932-3399
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. SON TRAN
Credential	:	DDS
Telephone Number	:	214-747-1400

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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