Provider Demographics
NPI:1427087352
Name:STARK, ROBERT ADRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ADRIAN
Last Name:STARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 ISAACS ORCHARD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6798
Mailing Address - Country:US
Mailing Address - Phone:479-717-2904
Mailing Address - Fax:501-423-8910
Practice Address - Street 1:6801 ISAACS ORCHARD RD STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6798
Practice Address - Country:US
Practice Address - Phone:479-717-2904
Practice Address - Fax:501-423-8910
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55141223G0001X
AR3348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR174669608Medicaid