Provider Demographics
NPI:1952788382
Name:ALL-STAR DENTAL CARE, PC
Entity Type:Organization
Organization Name:ALL-STAR DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPAETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-440-7781
Mailing Address - Street 1:830 TENDERFOOT HILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-2314
Mailing Address - Country:US
Mailing Address - Phone:719-440-7781
Mailing Address - Fax:
Practice Address - Street 1:830 TENDERFOOT HILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2314
Practice Address - Country:US
Practice Address - Phone:719-440-7781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty