Provider Demographics
NPI:1568878270
Name:STARR, AUSTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
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 1:473 S LANDMARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5005
Mailing Address - Country:US
Mailing Address - Phone:812-318-1023
Mailing Address - Fax:812-318-1643
Practice Address - Street 1:473 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5005
Practice Address - Country:US
Practice Address - Phone:812-318-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34341223S0112X
IN120129161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery