Provider Demographics
NPI:1003574336
Name:5 STAR SMILES DENTISTRY
Entity Type:Organization
Organization Name:5 STAR SMILES DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUSTAPHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-500-1276
Mailing Address - Street 1:9559 SW ANNA BELLE CT
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3349
Mailing Address - Country:US
Mailing Address - Phone:203-500-1276
Mailing Address - Fax:
Practice Address - Street 1:16755 SW BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4284
Practice Address - Country:US
Practice Address - Phone:203-645-4016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty