Provider Demographics
NPI:1790379667
Name:NORTH STAR IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:NORTH STAR IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMPF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-315-1400
Mailing Address - Street 1:150 BROADHOLLOW RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4901
Mailing Address - Country:US
Mailing Address - Phone:631-315-1400
Mailing Address - Fax:516-677-0064
Practice Address - Street 1:150 BROADHOLLOW RD STE 302
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4901
Practice Address - Country:US
Practice Address - Phone:631-315-1400
Practice Address - Fax:516-677-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356568737OtherNPI