Healthcare Provider Details

I. General information

NPI: 1528852191
Provider Name (Legal Business Name): ALEC STAROSTIK DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 UNIVERSITY DR
STATE COLLEGE PA
16801-6552
US

IV. Provider business mailing address

611 UNIVERSITY DR
STATE COLLEGE PA
16801-6552
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-0329
  • Fax:
Mailing address:
  • Phone: 814-234-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ALEC STAROSTIK
Title or Position: OWNER
Credential:
Phone: 814-234-0329