=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821096934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH DYNAMITE STARLING D.D.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6575 WEST LOOP S
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-664-7591
-----------------------------------------------------
Fax | 713-664-1925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6575 WEST LOOP S
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-664-7591
-----------------------------------------------------
Fax | 713-664-1925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 8333
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------