Healthcare Provider Details

I. General information

NPI: 1811063373
Provider Name (Legal Business Name): STAR DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LONG LN
UPPER DARBY PA
19082-3112
US

IV. Provider business mailing address

101 LONG LN
UPPER DARBY PA
19082-3112
US

V. Phone/Fax

Practice location:
  • Phone: 610-352-2263
  • Fax: 610-352-2261
Mailing address:
  • Phone: 610-352-2263
  • Fax: 610-352-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID Z DAI
Title or Position: OWNER
Credential: DMD
Phone: 610-352-2263