Active NPI
Cory Morris Stark, D.D.S.
- Pediatric Dentistry
- Draper, UT
National Provider Identifier
1962592329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 144937-9923
- Practice address
- 112 E 12450 S
100
Draper, UT 84020-8056 - Phone
- (801) 571-6751
- Fax
- (801) 571-4156
- NPI assigned
- Oct 13, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 144937-9923 | UT | Primary |
Addresses
Primary practice location
112 E 12450 S
100
Draper, UT 84020-8056
Mailing address
112 East 12450 South
100
Draper, UT 84020
Phone (801) 571-6751
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 |
|---|---|---|---|
| 144937-9923 | UT | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962592329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 EAST 12450 SOUTH",
"address_2": "100",
"city": "DRAPER",
"state": "UT",
"postal_code": "84020",
"telephone_number": "801-571-6751",
"fax_number": "801-571-4156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 E 12450 S",
"address_2": "100",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208056",
"telephone_number": "801-571-6751",
"fax_number": "801-571-4156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARK",
"first_name": "CORY",
"middle_name": "MORRIS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "UT",
"license": "144937-9923",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
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.