Provider Demographics
NPI:1275635708
Name:STARCK, THOMAS FREDERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FREDERIC
Last Name:STARCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 LANDUFF CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8837
Mailing Address - Country:US
Mailing Address - Phone:919-461-8409
Mailing Address - Fax:
Practice Address - Street 1:1010 HIGH HOUSE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3576
Practice Address - Country:US
Practice Address - Phone:919-467-2882
Practice Address - Fax:919-467-4012
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice