Provider Demographics
NPI:1275183279
Name:DENTAL STAR OF NEW JERSEY PC
Entity Type:Organization
Organization Name:DENTAL STAR OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:POTEPALOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-972-7770
Mailing Address - Street 1:74 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9209
Mailing Address - Country:US
Mailing Address - Phone:732-972-7770
Mailing Address - Fax:732-972-7705
Practice Address - Street 1:74 ROUTE 9
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9209
Practice Address - Country:US
Practice Address - Phone:732-972-7770
Practice Address - Fax:732-972-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty