Individual
DR. KELLY KRISTINE STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
17705 HUTCHINS DR STE 201, MINNETONKA, MN 55345-4103
(952) 474-5239
Mailing address
5212 LOGAN AVE S, MINNEAPOLIS, MN 55419-1022
(612) 922-9474
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11805
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323627700
—
MN
Enumeration date
12/08/2006
Last updated
08/01/2024
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