Individual
DR. MICHELE DEBRA STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
224 E WALL ST, WORDEN, IL 62097-1306
(618) 459-3626
(618) 459-7507
Mailing address
224 E WALL ST, WORDEN, IL 62097-1306
(618) 459-3626
(618) 459-7507
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003853
—
IL
Enumeration date
04/25/2007
Last updated
07/08/2007
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