MEDICARE: STARS DENTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4935	NV

General Provider Information

NPI Number	:	1275714875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARS DENTAL

Provider Business Mailing Address
First Line	:	7910 S RAINBOW BLVD
Second Line	:	SUITE 125
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6478
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7910 S RAINBOW BLVD
Second Line	:	SUITE 125
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6478
Country	:	US
Telephone Number	:	702-395-3047
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. PETER CHIEM
Credential	:
Telephone Number	:	702-395-3047

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	11/26/2007

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Directions to “STARS DENTAL ” Practice Location

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