Provider Demographics
NPI:1629616206
Name:STARKES, STACEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:STARKES
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 1:88 CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-5650
Mailing Address - Country:US
Mailing Address - Phone:585-261-8228
Mailing Address - Fax:
Practice Address - Street 1:1238 E RIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2012
Practice Address - Country:US
Practice Address - Phone:585-348-7793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-14
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist