Provider Demographics
NPI:1700441656
Name:ALL STAR DENTAL, LLC
Entity Type:Organization
Organization Name:ALL STAR DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-463-4110
Mailing Address - Street 1:522 E JASPER ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2437
Mailing Address - Country:US
Mailing Address - Phone:217-463-4110
Mailing Address - Fax:
Practice Address - Street 1:600 W NORTHFIELD DR STE 2020
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-9348
Practice Address - Country:US
Practice Address - Phone:217-463-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty