Provider Demographics
NPI:1568603819
Name:ROBERT STARK DDS PA
Entity Type:Organization
Organization Name:ROBERT STARK DDS PA
Other - Org Name:FOUNDERS PARK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-717-2904
Mailing Address - Street 1:6801 ISAACS ORCHARD RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6096
Mailing Address - Country:US
Mailing Address - Phone:479-717-2904
Mailing Address - Fax:501-423-8910
Practice Address - Street 1:6801 ISAACS ORCHARD RD
Practice Address - Street 2:STE. 101
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6096
Practice Address - Country:US
Practice Address - Phone:479-717-2904
Practice Address - Fax:501-423-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR174669608Medicaid