# STAR IMAGE DENTISTRY OF SOUTHLAKE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215856836
- **Authorized official:** BRENDA RODGERS (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (940) 322-2252

## Contact information

- **Practice address:** 1480 CORPORATE CIR STE 100, SOUTHLAKE, TX 76092-5963
- **Practice address phone:** (817) 587-4566
- **Practice address fax:** (817) 329-0076
- **Mailing address:** 1480 CORPORATE CIR STE 100, SOUTHLAKE, TX 76092-5963
- **Mailing address phone:** (817) 587-4566
- **Mailing address fax:** (817) 329-0076

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/15/2026
- **Last updated:** 07/15/2026