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General NPI Number Information
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NPI Number | 1679644710
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Entity Type | Individual
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Provider Name | RICHARD BRUCE STARK DDS
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Gender | Male
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 201 E 6TH ST
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City | MORRIS
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State | MN
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Zip | 56267-1212
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Country | US
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Telephone | 320-589-2161
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Fax | 320-589-3149
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Provider Business Mailing Address
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Address Line | 40612 STATE HIGHWAY 28
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City | CYRUS
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State | MN
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Zip | 56323-4600
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Country | US
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Telephone | 320-795-2828
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Fax | 320-589-3149
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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 | 8906
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License Number State | MN
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