Provider Demographics
NPI:1427262666
Name:STARLEY, JOHN ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:STARLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 HARRISON BLVD
Mailing Address - Street 2:#6
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2060
Mailing Address - Country:US
Mailing Address - Phone:801-621-3553
Mailing Address - Fax:801-392-6548
Practice Address - Street 1:3590 HARRISON BLVD
Practice Address - Street 2:#6
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2060
Practice Address - Country:US
Practice Address - Phone:801-621-3553
Practice Address - Fax:801-392-6548
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14046099221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528784676002Medicaid