Healthcare Provider Details

I. General information

NPI: 1821187931
Provider Name (Legal Business Name): ANITA ALBAUGH STARR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WEST MAIN ST.
WEST BRANCH IA
52358-0157
US

IV. Provider business mailing address

112 W. MAIN ST. P.O. BOX 157
WEST BRANCH IA
52358-0157
US

V. Phone/Fax

Practice location:
  • Phone: 319-643-4181
  • Fax: 319-643-3067
Mailing address:
  • Phone: 319-643-4181
  • Fax: 319-643-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7923
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: