Provider Demographics
NPI:1942601372
Name:STARR, MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:STARR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE CENTER WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8594
Mailing Address - Country:US
Mailing Address - Phone:561-798-0100
Mailing Address - Fax:561-798-0536
Practice Address - Street 1:1200 CORPORATE CENTER WAY STE 103
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8594
Practice Address - Country:US
Practice Address - Phone:561-798-0100
Practice Address - Fax:561-798-0536
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist