Healthcare Provider Details

I. General information

NPI: 1336137801
Provider Name (Legal Business Name): HEIDI J. STARK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
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 Number6310
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: