Provider Demographics
NPI:1518130764
Name:STARR GENERAL DENTISTRY
Entity Type:Organization
Organization Name:STARR GENERAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-776-7410
Mailing Address - Street 1:6400 COBBS DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710
Mailing Address - Country:US
Mailing Address - Phone:254-776-7410
Mailing Address - Fax:254-776-6207
Practice Address - Street 1:6400 COBBS DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710
Practice Address - Country:US
Practice Address - Phone:254-776-7410
Practice Address - Fax:254-776-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID NUMBER