DR. Derrik Palmer Stark, DDS

NPI #1346574316 in Longview, Washington

Provider Information

NPI Number: 1346574316
Entity Type: Individual
Name: DR. Derrik Palmer Stark, DDS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: DDS
Enumeration Date: Sep 23, 2009
Last Updated: Sep 23, 2009

Practice Location

Address: 820 OCEAN BEACH HWY
Address 2: SUITE 110
City: Longview
State: Washington
ZIP Code: 98632-4080
Phone: (360) 577-0566

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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