Provider Demographics
NPI:1235751330
Name:ALL STAR DENTAL, LLC
Entity Type:Organization
Organization Name:ALL STAR DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE AND BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AURELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-386-2700
Mailing Address - Street 1:150 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3812
Mailing Address - Country:US
Mailing Address - Phone:740-386-2700
Mailing Address - Fax:740-386-2710
Practice Address - Street 1:150 S STATE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3812
Practice Address - Country:US
Practice Address - Phone:740-386-2700
Practice Address - Fax:740-386-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty