Provider Demographics
NPI:1487319067
Name:LONE STAR SMILES PLLC
Entity type:Organization
Organization Name:LONE STAR SMILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLE
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SUTAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:806-666-1099
Mailing Address - Street 1:5607 114TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424
Mailing Address - Country:US
Mailing Address - Phone:806-666-1099
Mailing Address - Fax:
Practice Address - Street 1:5607 114TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-666-1099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental