Provider Demographics
NPI:1932861804
Name:GOLD STAR FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GOLD STAR FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:860-326-5313
Mailing Address - Street 1:489 GOLD STAR HWY
Mailing Address - Street 2:
Mailing Address - City:GRATON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:860-326-5313
Mailing Address - Fax:860-440-8447
Practice Address - Street 1:489 GOLD STAR HWY
Practice Address - Street 2:
Practice Address - City:GRATON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-326-5313
Practice Address - Fax:860-440-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty