MEDICARE: DR. FREDERICK WAYNE STARK DDS

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
1	1223G0001X	General Practice Dentistry	60680	KS

General Provider Information

NPI Number	:	1699901595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK WAYNE STARK DDS

Provider Business Mailing Address
First Line	:	700 N MAPLE ST
Second Line	:
City	:	MCPHERSON
State	:	KS
Zip	:	67460-3325
Country	:	US
Telephone Number	:	620-241-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 E MADISON AVE STE 600
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-2285
Country	:	US
Telephone Number	:	316-788-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	01/03/2019

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