Provider Demographics
NPI:1497711188
Name:STARR, IVAN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:L
Last Name:STARR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUMMIT AVENUE
Mailing Address - Street 2:STE 102
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-343-4616
Mailing Address - Fax:201-343-4739
Practice Address - Street 1:5 SUMMIT AVENUE
Practice Address - Street 2:STE 102
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-343-4616
Practice Address - Fax:201-343-4739
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1006838150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist