Provider Demographics
NPI:1326502840
Name:NORTHSTAR ADVENTURES
Entity Type:Organization
Organization Name:NORTHSTAR ADVENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STUCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-862-1106
Mailing Address - Street 1:1006 S FIVE SISTERS DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4070
Mailing Address - Country:US
Mailing Address - Phone:435-229-7029
Mailing Address - Fax:
Practice Address - Street 1:382 S BLUFF ST STE 250
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3672
Practice Address - Country:US
Practice Address - Phone:435-656-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty