Provider Demographics
NPI:1114966405
Name:STAPLETON, MARK FIELDING (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:FIELDING
Last Name:STAPLETON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 HARLOW RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1336
Mailing Address - Country:US
Mailing Address - Phone:541-736-5525
Mailing Address - Fax:
Practice Address - Street 1:498 HARLOW RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1336
Practice Address - Country:US
Practice Address - Phone:541-736-5525
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85701223P0221X
MT21161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry