Provider Demographics
NPI:1467278960
Name:MORNING STAR CHILDREN'S DENTISTRY, LLC
Entity type:Organization
Organization Name:MORNING STAR CHILDREN'S DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:GEDEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-687-8062
Mailing Address - Street 1:14255 COLLIER BLVD UNIT 120
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9858
Mailing Address - Country:US
Mailing Address - Phone:239-920-7827
Mailing Address - Fax:239-331-3080
Practice Address - Street 1:14255 COLLIER BLVD UNIT 120
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9858
Practice Address - Country:US
Practice Address - Phone:239-920-7827
Practice Address - Fax:239-331-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental