Provider Demographics
NPI:1588905897
Name:DENTAL STARZ, LLC
Entity type:Organization
Organization Name:DENTAL STARZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ILYAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-486-6500
Mailing Address - Street 1:4434A W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1932
Mailing Address - Country:US
Mailing Address - Phone:773-486-6500
Mailing Address - Fax:773-486-6556
Practice Address - Street 1:4434A W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1932
Practice Address - Country:US
Practice Address - Phone:773-486-6500
Practice Address - Fax:773-486-6556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL STARZ, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190267211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty