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General NPI Number Information
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NPI Number | 1346815107
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Entity Type | Individual
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Provider Name | FREDERICK STARK IV DDS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 3960 RIVER POINT PKWY UNIT A
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City | SHERIDAN
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State | CO
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Zip | 80110-3315
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Country | US
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Telephone | 303-781-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 1274 SMOKEY ROW LN
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City | CARMEL
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State | IN
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Zip | 46033-1949
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Country | US
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Telephone | 317-519-8074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00204708
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License Number State | CO
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