Provider Demographics
NPI:1588049480
Name:STAR DENTAL
Entity type:Organization
Organization Name:STAR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AROONE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-308-8051
Mailing Address - Street 1:5972 CAHILL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1521
Mailing Address - Country:US
Mailing Address - Phone:651-455-0068
Mailing Address - Fax:651-455-5133
Practice Address - Street 1:5972 CAHILL AVE STE 104
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1521
Practice Address - Country:US
Practice Address - Phone:651-455-0068
Practice Address - Fax:651-455-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND130591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty