Provider Demographics
NPI:1376708610
Name:STAR WHITE DENTAL CLINIC
Entity Type:Organization
Organization Name:STAR WHITE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BONG
Authorized Official - Middle Name:KOOG
Authorized Official - Last Name:NOH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-721-1730
Mailing Address - Street 1:2105 SAN JOAQUIN HILLS RD.
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-721-7130
Mailing Address - Fax:949-721-1709
Practice Address - Street 1:2105 SAN JOAQUIN HILLS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6507
Practice Address - Country:US
Practice Address - Phone:949-721-7130
Practice Address - Fax:949-721-1709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty