Provider Demographics
NPI:1659131258
Name:STELLAR DENTAL
Entity Type:Organization
Organization Name:STELLAR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:HUNG
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-266-0447
Mailing Address - Street 1:2100 N DAVIDSON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1828
Mailing Address - Country:US
Mailing Address - Phone:704-688-7120
Mailing Address - Fax:704-405-8815
Practice Address - Street 1:2100 N DAVIDSON ST UNIT B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1828
Practice Address - Country:US
Practice Address - Phone:704-688-7120
Practice Address - Fax:704-405-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty