=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275714875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STARS DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2007
-----------------------------------------------------
Last Update Date | 11/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7910 S RAINBOW BLVD SUITE 125
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89139-6478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-395-3047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7910 S RAINBOW BLVD SUITE 125
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89139-6478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. PETER CHIEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-395-3047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4935
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------