Provider Demographics
NPI:1962952606
Name:LODESTAR DENTAL LLC
Entity type:Organization
Organization Name:LODESTAR DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HO
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-334-5001
Mailing Address - Street 1:170 W MAIN ST
Mailing Address - Street 2:APT#205K
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2562
Mailing Address - Country:US
Mailing Address - Phone:714-334-5001
Mailing Address - Fax:
Practice Address - Street 1:474 FOXON BLVD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-2329
Practice Address - Country:US
Practice Address - Phone:714-334-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0106531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty