Provider Demographics
NPI:1295964104
Name:ALL STAR DENTAL
Entity type:Organization
Organization Name:ALL STAR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENGELAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-233-3503
Mailing Address - Street 1:201A E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1223
Mailing Address - Country:US
Mailing Address - Phone:636-938-7827
Mailing Address - Fax:636-938-5979
Practice Address - Street 1:201A E 5TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1223
Practice Address - Country:US
Practice Address - Phone:636-938-7827
Practice Address - Fax:636-938-5979
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARTHUR T ENGELAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002007232261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental