Provider Demographics
NPI:1023276292
Name:DENTAL STARZ, LLC
Entity type:Organization
Organization Name:DENTAL STARZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYAS
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-290-2023
Mailing Address - Street 1:75 W NORTH AVE # 400
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-2306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121 S WOLF RD APT 412
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:IL
Practice Address - Zip Code:60162-2144
Practice Address - Country:US
Practice Address - Phone:630-290-2023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026721261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental