Provider Demographics
NPI:1285762237
Name:STARR, JOHN W JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:STARR
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 BLUECUTT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1470
Mailing Address - Country:US
Mailing Address - Phone:662-329-2696
Mailing Address - Fax:
Practice Address - Street 1:2900 BLUECUTT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1470
Practice Address - Country:US
Practice Address - Phone:662-329-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPER154-881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics