Provider Demographics
NPI:1942471586
Name:DENTAL STAR
Entity Type:Organization
Organization Name:DENTAL STAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:POTEPALOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-972-7770
Mailing Address - Street 1:74 PHILIP PLAZA UNIT C
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726
Mailing Address - Country:US
Mailing Address - Phone:732-972-7770
Mailing Address - Fax:732-972-7705
Practice Address - Street 1:74 PHILLIP LN
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8335
Practice Address - Country:US
Practice Address - Phone:732-972-7770
Practice Address - Fax:732-972-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02284000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental