Individual
DR. FREDERICK WAYNE STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1710 E MADISON AVE STE 600, DERBY, KS 67037-2285
(316) 788-4000
Mailing address
700 N MAPLE ST, MCPHERSON, KS 67460-3325
(620) 241-5000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
60680
KS
Other
Enumeration date
06/05/2009
Last updated
01/03/2019
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