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General NPI Number Information
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NPI Number | 1780437996
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Entity Type | Organization
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Legal Business Name | STAR TEK ADULT DENTAL GROUP
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 815 CECIL AVE
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City | DELANO
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State | CA
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Zip | 93215-1716
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Country | US
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Telephone | 323-203-2564
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Fax |
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Provider Business Mailing Address
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Address Line | 5449 HOLLYWOOD BLVD STE A
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City | LOS ANGELES
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State | CA
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Zip | 90027-3454
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Country | US
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Telephone | 323-203-2564
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Fax |
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Authorized Official
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Title or Position | ADMINISTATOR
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Name | MRS. MICHELLE AMMONS
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Credential | HR
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Telephone | 661-312-1433
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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 |
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License Number State |
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