Organization
BLUE STAR DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORINA NASTASE DMD (DENTIST)
(773) 698-5773
Entity
Organization
Contact information
Practice address
4703 W LAWRENCE AVE, CHICAGO, IL 60630-1722
(773) 698-5773
Mailing address
5711 N KIMBALL AVE, APT 1N, CHICAGO, IL 60659-4523
(773) 698-5773
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019030349
IL
Other
Enumeration date
01/06/2017
Last updated
01/06/2017
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