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General NPI Number Information
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NPI Number | 1336710540
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Entity Type | Organization
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Legal Business Name | GOLD STAR DENTAL LLC
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 4057 OLD ORCHARD RD # NORTH
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City | SKOKIE
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State | IL
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Zip | 60076-1001
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Country | US
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Telephone | 847-329-1314
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Fax | 847-329-9116
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Provider Business Mailing Address
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Address Line | 4057 OLD ORCHARD RD # NORTH
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City | SKOKIE
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State | IL
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Zip | 60076-1001
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Country | US
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Telephone | 847-329-1314
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Fax | 847-329-1314
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Authorized Official
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Title or Position | MEMBER
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Name | MS. DORINA NASTASE
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Credential | DMD
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Telephone | 773-698-5773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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