Provider Demographics
NPI:1356978753
Name:STARR ORAL & MAXILLOFACIAL SURGERY, LLC
Entity type:Organization
Organization Name:STARR ORAL & MAXILLOFACIAL SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-318-1023
Mailing Address - Street 1:473 S LANDMARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5005
Mailing Address - Country:US
Mailing Address - Phone:812-318-1023
Mailing Address - Fax:812-318-1643
Practice Address - Street 1:473 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5005
Practice Address - Country:US
Practice Address - Phone:812-318-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty