Provider Demographics
NPI:1801136973
Name:NORTHSTAR DENTAL CARE LLC
Entity type:Organization
Organization Name:NORTHSTAR DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BASSIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-365-5000
Mailing Address - Street 1:430 NAZARETH PIKE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064
Mailing Address - Country:US
Mailing Address - Phone:610-365-5000
Mailing Address - Fax:
Practice Address - Street 1:430 NAZARETH PIKE
Practice Address - Street 2:SUITE 2A
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9683
Practice Address - Country:US
Practice Address - Phone:610-365-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030891L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7333470001Medicare NSC