Provider Demographics
NPI:1114040854
Name:STAPLEY, SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:STAPLEY
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 1:308 N WHITE MOUNTAIN RD
Mailing Address - Street 2:SUITE #D
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5260
Mailing Address - Country:US
Mailing Address - Phone:928-367-2776
Mailing Address - Fax:928-367-2776
Practice Address - Street 1:308 N WHITE MOUNTAIN RD
Practice Address - Street 2:SUITE #D
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5260
Practice Address - Country:US
Practice Address - Phone:928-367-2776
Practice Address - Fax:928-367-2776
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice