MEDICARE: DAVID D. STARR DMDMS

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	12776	OH

General Provider Information

NPI Number	:	1790957140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID D. STARR DMDMS

Provider Business Mailing Address
First Line	:	PO BOX 46613
Second Line	:
City	:	BEDFORD
State	:	OH
Zip	:	44146-0613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 E WASHINGTON ST
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-4510
Country	:	US
Telephone Number	:	440-543-3223
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID D STARR
Credential	:	D.M.D.M.S.
Telephone Number	:	440-543-3223

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/26/2008

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