MEDICARE: STARS DENTAL P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	047068	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336350370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARS DENTAL P.C.

Provider Business Mailing Address
First Line	:	1501 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3807
Country	:	US
Telephone Number	:	718-336-4521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3807
Country	:	US
Telephone Number	:	718-336-4521
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANGELA LO
Credential	:	DDS
Telephone Number	:	646-247-7367

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	03/26/2013

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