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General NPI Number Information
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NPI Number | 1457969909
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Entity Type | Organization
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Legal Business Name | FIVE STAR ORTHODONTIC LABORATORY & SUPPLY, INC.
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 2928 METRO ST STE 102
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City | DENTON
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State | TX
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Zip | 76207-4304
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Country | US
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Telephone | 800-521-2351
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 888
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City | DENTON
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State | TX
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Zip | 76202-0888
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. ANDREW LOCH
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Credential |
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Telephone | 800-521-2351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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