Provider Demographics
NPI:1659432334
Name:STAR, MARC DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:DAVID
Last Name:STAR
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 1:3201 ROGERS AVE 303
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4589
Mailing Address - Country:US
Mailing Address - Phone:410-750-3583
Mailing Address - Fax:410-480-0290
Practice Address - Street 1:3201 ROGERS AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4594
Practice Address - Country:US
Practice Address - Phone:410-750-3583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice