Healthcare Provider Details

I. General information

NPI: 1376664680
Provider Name (Legal Business Name): BARRY I STARK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 NOTCH HILL RD
NORTH BRANFORD CT
06471-1826
US

IV. Provider business mailing address

PO BOX 193
NORTH BRANFORD CT
06471-0193
US

V. Phone/Fax

Practice location:
  • Phone: 203-488-6343
  • Fax: 203-488-6185
Mailing address:
  • Phone: 204-488-6343
  • Fax: 203-488-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4258
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: