Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1629137054 Individual Practitioner Female Practitioner

Dr. Kelly Kristine Stark , DDS

Dentist - General Practice • Minnetonka, MN

Professional Overview & Biography Verified Profile Summary

Dr. Kelly Stark, DDS is a registered healthcare professional specializing in Dentist - General Practice in Minnetonka, MN. Practice services are available at 17705 HUTCHINS DR STE 201 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

17705 Hutchins Dr Ste 201

Minnetonka, MN 553454103

Telephone 9524745239
Associated Practice Facility / Clinic
🏢 Asp Dental, Pc Facility NPI 1235746058

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Minnetonka, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 33.3 Yrs
Regional Practice Density
31 Specialists

Practicing in Minnetonka, MN (2262 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-08-01
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MN D11805

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
323627700 (MN)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners
NPI 1306948740

Doctor of Dental Surgery

NPI 1467554709

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location August 01, 2024

Registered at 17705 HUTCHINS DR STE 201, MINNETONKA, MN 553454103 (Tel: 9524745239)

👤
Provider Name / Credentials Updated August 01, 2024

Recorded as KELLY STARK, DDS

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 15785 95TH AVE N, MAPLE GROVE, MN 553694404 (Tel: 7634205484)

📍
Updated Business Mailing Address July 08, 2007

Registered at 5212 LOGAN AVE S, MINNEAPOLIS, MN 554191022 (Tel: 6129229474)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as KELLY MEHTA, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #D11805 in MN)

🟢
Initial NPI Registration & Enumeration December 08, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1629137054
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 08, 2006
Last Update: August 01, 2024
Sole Proprietor: No

Mailing Address

5212 Logan Ave S

Minneapolis, MN 554191022

Phone: 6129229474

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.