Provider Demographics
NPI:1235264292
Name:STAPLETON, DAVID TAYLOR (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TAYLOR
Last Name:STAPLETON
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 1:12810 E 101ST PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4662
Mailing Address - Country:US
Mailing Address - Phone:918-376-2191
Mailing Address - Fax:918-376-2212
Practice Address - Street 1:12810 E 101ST PL N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4662
Practice Address - Country:US
Practice Address - Phone:918-376-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5727-511223P0300X
OK5727122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics