Provider Demographics
NPI:1871174730
Name:JEREMY M. STARR, DDS, INC.
Entity type:Organization
Organization Name:JEREMY M. STARR, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-769-8486
Mailing Address - Street 1:6211 PRINCESS CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4769
Mailing Address - Country:US
Mailing Address - Phone:916-769-8486
Mailing Address - Fax:916-945-0123
Practice Address - Street 1:927 RESERVE DR STE B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1383
Practice Address - Country:US
Practice Address - Phone:916-945-9599
Practice Address - Fax:916-945-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental