Provider Demographics
NPI:1013015239
Name:STARK, BEATRICE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:ANN
Last Name:STARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8551 W LAKE MEAD BLVD
Mailing Address - Street 2:#260
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7642
Mailing Address - Country:US
Mailing Address - Phone:702-437-1007
Mailing Address - Fax:702-304-1126
Practice Address - Street 1:8551 W LAKE MEAD BLVD
Practice Address - Street 2:#260
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7642
Practice Address - Country:US
Practice Address - Phone:702-437-1007
Practice Address - Fax:702-304-1126
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV35851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice