Healthcare Provider Details

I. General information

NPI: 1871774935
Provider Name (Legal Business Name): ROBERT WAYNE STARR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PRISON RD
REPRESA CA
95671-3001
US

IV. Provider business mailing address

300 PRISON RD
REPRESA CA
95671-3001
US

V. Phone/Fax

Practice location:
  • Phone: 916-719-0124
  • Fax:
Mailing address:
  • Phone: 916-719-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number033154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: