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General NPI Number Information
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NPI Number | 1750822748
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Entity Type | Organization
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Legal Business Name | STAR DENTAL P.C.
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Dates
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Enumeration Date | 03/10/2017
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Last Update Date | 03/10/2017
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Provider Practice Location Address
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Address Line | 775 BALDWIN RD SUITE C
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City | PONTIAC
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State | MI
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Zip | 48340
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Country | US
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Telephone | 248-338-3000
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Fax | 248-338-3173
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Provider Business Mailing Address
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Address Line | 775 BALDWIN RD SUITE C
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City | PONTIAC
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State | MI
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Zip | 48340
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Country | US
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Telephone | 248-338-3000
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Fax | 248-338-3173
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SIRAN S. RAOUF
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Credential | DDS
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Telephone | 248-338-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901018555
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License Number State | MI
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