Kasey Marie Stark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901022317 Issued in MI

Practice address

380 N State Rd
Otisville, MI 48463-9486

Phone

(810) 631-4524

NPI assigned

Jun 18, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kids Tooth Team Fenton PPLC

  • Pediatric Dentistry
  • Fenton, MI
  • NPI 1073473237
  NPD Authorized official
• Kids Tooth Team Lake Orion PLLC

  • Pediatric Dentistry
  • Lake Orion, MI
  • NPI 1154105542
  NPD Authorized official
• G & J Dental PC

  • General Practice Dentistry
  • Otisville, MI
  • NPI 1649160995
  NPD (past)
• Great Lakes Family Dental Group - Otisville, P.C.

  • General Practice Dentistry
  • Otisville, MI
  • NPI 1568554681
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497744000000",
    "number": "1477083855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 E KIRBY ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482024122",
            "telephone_number": "810-252-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 N STATE RD",
            "city": "OTISVILLE",
            "state": "MI",
            "postal_code": "484639486",
            "telephone_number": "810-631-4524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "KASEY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-18",
        "last_updated": "2017-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901022317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohamed Ally Health Plaza PLLC
• William E Norton II, D.D.S.
• Otisville Pharmacy LLC
• Rite Aid of Michigan Inc
• Amanda Renee Southern, LMSW
• Kathy Taliaferro
• Tranquil Life Counseling LLC
• William Wise

• General Practice Dentistry in Otisville, MI
• Providers in Otisville, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.