Provider Demographics
NPI:1528353026
Name:NORTH STAR DME &DENTAL LAB INC.
Entity type:Organization
Organization Name:NORTH STAR DME &DENTAL LAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELITO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-628-5685
Mailing Address - Street 1:559 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3027
Mailing Address - Country:US
Mailing Address - Phone:224-676-1052
Mailing Address - Fax:847-947-2194
Practice Address - Street 1:559 N WOLF RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3027
Practice Address - Country:US
Practice Address - Phone:224-676-1052
Practice Address - Fax:847-947-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-300-0047-0280OtherDRIVERS LIC.