# STAR DENTAL CLINIC LLC

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

## Provider details

- **NPI number:** 1437422680
- **Authorized official:** DR. ESTHER RUSSTOM GHEBREMICHAEL D.D.S. (OWNER)
- **Authorized official phone:** (317) 414-8822

## Contact information

- **Practice address:** 5330 W WASHINGTON ST, INDIANAPOLIS, IN 46241-2147
- **Practice address phone:** (317) 414-8822
- **Mailing address:** 5330 W WASHINGTON ST, INDIANAPOLIS, IN 46241-2147
- **Mailing address phone:** (317) 414-8822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12011343A | IN | Yes |

## Other

- **Enumeration date:** 02/20/2012
- **Last updated:** 02/20/2012