| Star Dental Institute Inc | |
|
2620 Tenderfoot Hill St Ste 210 Colorado Springs CO 80906-8356 | |
| (719) 597-7979 | |
| Not Available |
| Full Name | Star Dental Institute Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2620 Tenderfoot Hill St Ste 210, Colorado Springs, Colorado |
| Authorized Official Name and Position | Gary Moore (DENTIST) |
| Authorized Official Contact | 7195977979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Star Dental Institute Inc 2620 Tenderfoot Hill St Ste 210 Colorado Springs CO 80906-8356 Ph: (719) 597-7979 | Star Dental Institute Inc 2620 Tenderfoot Hill St Ste 210 Colorado Springs CO 80906-8356 Ph: (719) 597-7979 |
| NPI Number | 1881255107 |
|---|---|
| Provider Enumeration Date | 06/26/2019 |
| Last Update Date | 04/07/2020 |
| Medicare PECOS PAC ID | 1153751243 |
|---|---|
| Medicare Enrollment ID | O20200413001607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881255107 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Gary N Moore |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1376522979 PECOS PAC ID: 2466771175 Enrollment ID: I20200413001807 |
| Provider Name | Seongryeol A Kim |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1154487445 PECOS PAC ID: 8628109147 Enrollment ID: I20200413002162 |
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