Healthcare Provider Details

I. General information

NPI: 1518698950
Provider Name (Legal Business Name): JAKOB STARK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86TH MEDICAL GROUP UNIT 3215 RAMSTEIN AIR BASE
APO AE
09094-3215
US

IV. Provider business mailing address

86TH MEDICAL GROUP UNIT 3215 RAMSTEIN AIR BASE
APO AE
09094-3215
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2210
  • Fax:
Mailing address:
  • Phone: 314-479-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-5411
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: