Provider Demographics
NPI:1659704799
Name:STARK, JOHN KYLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KYLE
Last Name:STARK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BUSINESS PARK CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3182
Mailing Address - Country:US
Mailing Address - Phone:855-308-8615
Mailing Address - Fax:
Practice Address - Street 1:3000 BUSINESS PARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3182
Practice Address - Country:US
Practice Address - Phone:615-855-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL11938122300000X
TN101361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist