Healthcare Provider Details

I. General information

NPI: 1013219633
Provider Name (Legal Business Name): STARK AND JOHNSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3272 SALT CREEK CIR SUITE A
LINCOLN NE
68504-4759
US

IV. Provider business mailing address

3272 SALT CREEK CIR SUITE A
LINCOLN NE
68504-4759
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-1500
  • Fax: 402-476-1510
Mailing address:
  • Phone: 402-476-1500
  • Fax: 402-476-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNI K WALL
Title or Position: INSURANCE AND BILLING MANAGER
Credential:
Phone: 402-476-1500