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Organization
STARLIGHT DENTAL SERVICES INC
Active
Organization
STARLIGHT DENTAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALBERT TAE JD (CEO)
(424) 392-2715
Entity
Organization
Contact information
Practice address
3440 W CACTUS RD STE 1, PHOENIX, AZ 85029-2238
(623) 688-3364
(623) 244-0333
Mailing address
3440 W CACTUS RD STE 1, PHOENIX, AZ 85029-2238
(623) 688-3364
(623) 244-0333
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
NULL
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
NULL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
124Q00000X
Dental Hygienist
—
NULL
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
NULL
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020P06513
ARIZONA DEPARTMENT OF PUBLIC SAFETY
AZ
Enumeration date
11/17/2020
Last updated
04/23/2023
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