Provider Demographics
NPI:1497232342
Name:STAPLETON, KIM (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 NW 24TH WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5421
Mailing Address - Country:US
Mailing Address - Phone:917-817-7968
Mailing Address - Fax:
Practice Address - Street 1:5779 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4616
Practice Address - Country:US
Practice Address - Phone:954-580-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN240791223X0400X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics