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General NPI Number Information
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NPI Number | 1871174730
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Entity Type | Organization
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Legal Business Name | JEREMY M. STARR, DDS, INC.
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 927 RESERVE DR STE B
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City | ROSEVILLE
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State | CA
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Zip | 95678-1383
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Country | US
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Telephone | 916-945-9599
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Fax | 916-945-0123
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Provider Business Mailing Address
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Address Line | 6211 PRINCESS CT
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City | ROCKLIN
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State | CA
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Zip | 95765-4769
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Country | US
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Telephone | 916-769-8486
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Fax | 916-945-0123
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Authorized Official
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Title or Position | CEO
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Name | DR. JEREMY MARTIN STARR
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Credential | DDS
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Telephone | 916-769-8486
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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 |
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License Number State |
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