Provider Demographics
NPI:1336710540
Name:GOLD STAR DENTAL LLC
Entity Type:Organization
Organization Name:GOLD STAR DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASTASE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-698-5773
Mailing Address - Street 1:4057 OLD ORCHARD RD # NORTH
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1001
Mailing Address - Country:US
Mailing Address - Phone:847-329-1314
Mailing Address - Fax:847-329-1314
Practice Address - Street 1:4057 OLD ORCHARD RD # NORTH
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1001
Practice Address - Country:US
Practice Address - Phone:847-329-1314
Practice Address - Fax:847-329-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty