Provider Demographics
NPI:1366869273
Name:TEXAS STAR DENTAL CENTER PA
Entity type:Organization
Organization Name:TEXAS STAR DENTAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:BSOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-682-2700
Mailing Address - Street 1:7706 BANDERA ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238
Mailing Address - Country:US
Mailing Address - Phone:210-523-2700
Mailing Address - Fax:210-523-2701
Practice Address - Street 1:7706 BANDERA ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238
Practice Address - Country:US
Practice Address - Phone:210-523-2700
Practice Address - Fax:210-523-2701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS STAR DENTAL CENTER PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-28
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty