Healthcare Provider Details

I. General information

NPI: 1134353295
Provider Name (Legal Business Name): STARS DENTAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 57TH STREET 1ST FL
BROOKLYN NY
11220
US

IV. Provider business mailing address

821 57TH STREET 1ST FL
BROOKLYN NY
11220
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-0313
  • Fax:
Mailing address:
  • Phone: 718-646-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA LO
Title or Position: DENTIST
Credential:
Phone: 718-886-7222