# STARLIGHT DENTAL SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063015576
- **Authorized official:** MR. ALBERT TAE JD (CEO)
- **Authorized official phone:** (424) 392-2715

## Contact information

- **Practice address:** 3440 W CACTUS RD STE 1, PHOENIX, AZ 85029-2238
- **Practice address phone:** (623) 688-3364
- **Practice address fax:** (623) 244-0333
- **Mailing address:** 3440 W CACTUS RD STE 1, PHOENIX, AZ 85029-2238
- **Mailing address phone:** (623) 688-3364
- **Mailing address fax:** (623) 244-0333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 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

- **Enumeration date:** 11/17/2020
- **Last updated:** 04/23/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2020P06513 | ARIZONA DEPARTMENT OF PUBLIC SAFETY | AZ |