Provider Demographics
NPI:1134402969
Name:STARKS, BIANCA DOMINIQUE (DMD)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:DOMINIQUE
Last Name:STARKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 N US HIGHWAY 77
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1880
Mailing Address - Country:US
Mailing Address - Phone:972-937-3501
Mailing Address - Fax:
Practice Address - Street 1:895 N US HIGHWAY 77
Practice Address - Street 2:SUITE 400
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1880
Practice Address - Country:US
Practice Address - Phone:972-937-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice