Active NPI
Matthew Jon Stark, DDS
- Dentist
- Minneapolis, MN
National Provider Identifier
1154519296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14862
- Practice address
- 1000 E Lake St
Minneapolis, MN 55407-1617 - Phone
- (612) 821-2017
- NPI assigned
- Oct 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 56420 | CA | |
| Dentist | 122300000X | D14862 | MN | Primary |
Addresses
Primary practice location
1000 E Lake St
Minneapolis, MN 55407-1617
Mailing address
1000 E Lake St
Minneapolis, MN 55407-1617
Phone (612) 821-2017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56420 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781568000000",
"number": "1154519296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 E LAKE ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071617",
"telephone_number": "612-821-2017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E LAKE ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071617",
"telephone_number": "612-821-2017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "MATTHEW",
"middle_name": "JON",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-12",
"last_updated": "2026-06-16",
"certification_date": "2026-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "56420",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.