Active NPI
Richard Bruce Stark, DDS
- Dentist
- Morris, MN
National Provider Identifier
1679644710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8906
- Practice address
- 201 E 6TH St
Morris, MN 56267-1212 - Phone
- (320) 589-2161
- Fax
- (320) 589-3149
- NPI assigned
- Nov 12, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8906 | MN | Primary |
Addresses
Primary practice location
201 E 6TH St
Morris, MN 56267-1212
Mailing address
40612 State Highway 28
Cyrus, MN 56323-4600
Phone (320) 795-2828
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 |
|---|---|---|---|
| 8906 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morris Dental Clinic | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Morris, MN
- NPI 1003124074
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679644710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40612 STATE HIGHWAY 28",
"city": "CYRUS",
"state": "MN",
"postal_code": "563234600",
"telephone_number": "320-795-2828",
"fax_number": "320-589-3149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 E 6TH ST",
"city": "MORRIS",
"state": "MN",
"postal_code": "562671212",
"telephone_number": "320-589-2161",
"fax_number": "320-589-3149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "RICHARD",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "8906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morris, MN
- Liberty D Sleiter, LICSW
- Levi Jacob Smith, OD
- Adam John Sommers, DO
- Michael Paul Sprengeler, PHARMD
- Lauren Davitt Squinobal, PT
- Kevin Stefanek, PHD
- Katelyn Steinlicht, MD
- Stevens Community Medical Center Inc
- Stevens Community Medical Center Inc
- Stevens Community Medical Center Inc (Stevens Community Medical Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.