Organization
STAR DENTAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ESTHER RUSSTOM GHEBREMICHAEL D.D.S. (OWNER)
(317) 414-8822
Entity
Organization
Contact information
Practice address
5330 W WASHINGTON ST, INDIANAPOLIS, IN 46241-2147
(317) 414-8822
Mailing address
5330 W WASHINGTON ST, INDIANAPOLIS, IN 46241-2147
(317) 414-8822
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011343A
IN
Other
Enumeration date
02/20/2012
Last updated
02/20/2012
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