Provider Demographics
NPI: | 1851682645 |
---|---|
Name: | DR. DAVID D STARR LLC |
Entity Type: | Organization |
Organization Name: | DR. DAVID D STARR LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | STARR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 440-543-3223 |
Mailing Address - Street 1: | 313 CANAL AVE SE |
Mailing Address - Street 2: | B |
Mailing Address - City: | NEW PHILADELPHIA |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44663-2359 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 330-339-8888 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 313 CANAL AVE SE |
Practice Address - Street 2: | B |
Practice Address - City: | NEW PHILADELPHIA |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44663-2359 |
Practice Address - Country: | US |
Practice Address - Phone: | 330-339-8888 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-04-27 |
Last Update Date: | 2011-04-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 12776 | 1223X0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223X0400X | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | Group - Single Specialty |