MEDICARE: DR. KENNETH EDWARD STARLING JR. D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	GA10177	GA

General Provider Information

NPI Number	:	1326262643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH EDWARD STARLING JR. D.D.S.

Provider Business Mailing Address
First Line	:	131 LANGLEY DR STE A
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-6909
Country	:	US
Telephone Number	:	770-963-8085
Fax Number	:	770-682-6951

Provider Business Practice Location Address
First Line	:	131 LANGLEY DR STE A
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-6909
Country	:	US
Telephone Number	:	770-963-8085
Fax Number	:	770-682-6951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	12/29/2021

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Directions to “ DR. KENNETH EDWARD STARLING JR. D.D.S.” Practice Location

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