Provider Demographics
NPI:1508065038
Name:STARACE, JASON JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JAMES
Last Name:STARACE
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 1:2000 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2811
Mailing Address - Country:US
Mailing Address - Phone:516-771-5251
Mailing Address - Fax:516-378-4543
Practice Address - Street 1:2000 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2811
Practice Address - Country:US
Practice Address - Phone:516-771-5251
Practice Address - Fax:516-378-4543
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist