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General NPI Number Information
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NPI Number | 1376863589
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Entity Type | Organization
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Legal Business Name | NORTHSTAR FAMILY DENTAL
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 538 POLARIS PKWY
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City | WESTERVILLE
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State | OH
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Zip | 43082-7044
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Country | US
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Telephone | 614-891-4242
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Fax | 614-891-4442
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Provider Business Mailing Address
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Address Line | 538 POLARIS PKWY
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City | WESTERVILLE
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State | OH
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Zip | 43082-7044
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Country | US
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Telephone | 614-891-4242
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Fax | 614-891-4442
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTINA KULESA
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Credential |
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Telephone | 614-891-4242
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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 | 30-22214
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License Number State | OH
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