Provider Demographics
NPI:1457969909
Name:FIVE STAR ORTHODONTIC LABORATORY & SUPPLY, INC.
Entity type:Organization
Organization Name:FIVE STAR ORTHODONTIC LABORATORY & SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-521-2351
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-0888
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2928 METRO ST STE 102
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-4304
Practice Address - Country:US
Practice Address - Phone:800-521-2351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory