Provider Demographics
NPI:1376863589
Name:NORTHSTAR FAMILY DENTAL
Entity Type:Organization
Organization Name:NORTHSTAR FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KULESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-891-4242
Mailing Address - Street 1:538 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7044
Mailing Address - Country:US
Mailing Address - Phone:614-891-4242
Mailing Address - Fax:614-891-4442
Practice Address - Street 1:538 POLARIS PKWY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7044
Practice Address - Country:US
Practice Address - Phone:614-891-4242
Practice Address - Fax:614-891-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-22214261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental