Provider Demographics
NPI:1336137801
Name:STARK, HEIDI J (DDS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:J
Last Name:STARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3272 SALT CREEK CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-4759
Mailing Address - Country:US
Mailing Address - Phone:402-476-1500
Mailing Address - Fax:402-476-1510
Practice Address - Street 1:3272 SALT CREEK CIR
Practice Address - Street 2:SUITE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-4759
Practice Address - Country:US
Practice Address - Phone:402-476-1500
Practice Address - Fax:402-476-1510
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2024-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE63101223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6310OtherLICENSE#