Healthcare Provider Details

I. General information

NPI: 1336710540
Provider Name (Legal Business Name): GOLD STAR DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 OLD ORCHARD RD # NORTH
SKOKIE IL
60076-1001
US

IV. Provider business mailing address

4057 OLD ORCHARD RD # NORTH
SKOKIE IL
60076-1001
US

V. Phone/Fax

Practice location:
  • Phone: 847-329-1314
  • Fax: 847-329-9116
Mailing address:
  • Phone: 847-329-1314
  • Fax: 847-329-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DORINA NASTASE
Title or Position: MEMBER
Credential: DMD
Phone: 773-698-5773