Kelly Kristine Stark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11805 Issued in MN

Practice address

17705 Hutchins Dr Ste 201
Minnetonka, MN 55345-4103

Phone

(952) 474-5239

NPI assigned

Dec 8, 2006

Last updated

Aug 1, 2024By the provider in NPPES

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

Other identifiers 1

Other names 1

• Dr. Kelly Kristine Mehta Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 27, 2016 through Jan 27, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Asp Dental, PC

  dba Lake Minnetonka Family Dental

  • Dental Clinic/Center
  • Minnetonka, MN
  • NPI 1235746058
  NPD
• Champlin Family Dental PA

  • General Practice Dentistry
  • Champlin, MN
  • NPI 1992818751
  NPD (past)
• Charles L Hirt DDS PA

  • Dentist
  • Minnetonka, MN
  • NPI 1992807333
  NPD (past)

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1629137054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5212 LOGAN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554191022",
            "telephone_number": "612-922-9474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR STE 201",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454103",
            "telephone_number": "952-474-5239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "KELLY",
        "middle_name": "KRISTINE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-08",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "323627700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MEHTA",
            "middle_name": "KRISTINE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Amber Lee Stamey, FNP-C
• Lori Jayne Stamm
• Jenna Stangland
• Marie Hill Stanley
• Kenneth John Starcznski, DDS
• Megan Stark, NP
• Abigail Mae Starke
• Tamara Wilson Starkey, MSW, LICSW
• Leslie Ann Stasiewski, APNP
• STCH Wayzata MN LLC (St Croix Hospice)

• General Practice Dentistry in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.