Provider Demographics
NPI:1235732165
Name:STARCK, DANA JULIE (RDH)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:JULIE
Last Name:STARCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 ISABELLA LN STE 101
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-9102
Mailing Address - Country:US
Mailing Address - Phone:615-778-0810
Mailing Address - Fax:
Practice Address - Street 1:8112 ISABELLA LN STE 101
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-9102
Practice Address - Country:US
Practice Address - Phone:615-778-0810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1003621124Q00000X
TN10245124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003621OtherRDH LICENSE