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DR. KELLY KRISTINE STARK DDS
NPI 1629137054
Dentist - General Practice in Minnetonka, MN

Active since December 08, 2006Opted out of Medicare · through Jan 27, 2028
17705 HUTCHINS DR STE 201, MINNETONKA, MN 55345(952) 474-5239 Get Directions Write a Review

NPPES record last updated: August 1, 2024. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Dr. Kelly Kristine Stark Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY KRISTINE STARK DDS (NPI 1629137054) is an individual general practice provider in Minnetonka, Minnesota, licensed in Minnesota (D11805) and active in the NPI registry since December 2006. She has opted out of Medicare through January 27, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1629137054
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameDR. KELLY KRISTINE STARKCredential: DDS
Location Address17705 HUTCHINS DR STE 201Minnetonka, MN 55345-4103
Mailing Address5212 Logan Ave SMinneapolis, MN 55419-1022 · (612) 922-9474
Phone(952) 474-5239
Sole ProprietorNo
Enumeration DateDecember 8, 2006
Last NPPES UpdateAugust 1, 2024
NPPES CertifiedAugust 1, 2024
✔ NPI 1629137054 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in MN · D11805
Definition
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.
17705 HUTCHINS DR STE 201, Minnetonka, MN 55345
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Other Names 1

Professional Name (2)Dr. Kelly Kristine Mehta Dds

Other Identifiers 1

Medicaid323627700MN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Kelly Kristine Stark Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 27, 2016 through January 27, 2028.

Opt-Out Effective DateJanuary 27, 2016
Opt-Out In Effect ThroughJanuary 27, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55345 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ASP DENTAL, PC
Clinic/Center (Dental)
17705 HUTCHINS DR STE 201
MINNETONKA, MN 55345
Hennepin County (952) 474-5239

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Stark's NPI number?

The NPI number for Kelly Stark is 1629137054. It was assigned to this individual provider in the NPPES registry on December 8, 2006. The provider is also known as Dr. Kelly Kristine Mehta Dds.

Where is Kelly Stark located?

Kelly Stark practices at 17705 Hutchins Dr Ste 201, Minnetonka, MN 55345. The listed phone number is (952) 474-5239.

What is Kelly Stark's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Kelly Stark enrolled in Medicare?

No. Kelly Stark has opted out of Medicare through January 27, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Kelly Stark accept?

Health plans from Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Florida Combined Life and 1 other insurer list Kelly Stark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Stark was last updated on August 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.