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NPI Code Detail

MEDICARE: DR. DYLAN STARCK DMD, MD

MEDICARE: DR. DYLAN STARCK DMD, MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)2952000584MI
21223S0112XOral and Maxillofacial Surgery (Dentist)2901600432MI

General Provider Information

NPI Number : 1417519331
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DYLAN STARCK DMD, MD
Provider Business Mailing Address
First Line : 2637 2ND AVE
Second Line :
City : MONROE
State : WI
Zip : 53566-3501
Country : US
Telephone Number : 608-214-7399
Fax Number :
Provider Business Practice Location Address
First Line : 1539 W MARKET ST
Second Line :
City : MEQUON
State : WI
Zip : 53092-5053
Country : US
Telephone Number : 82-147-3996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2019
Last Update Date : 06/17/2025

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