Provider Demographics
NPI:1497978878
Name:STAPLETON, MARK MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MARTIN
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 1:1580 WHITE OAK DR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2919
Mailing Address - Country:US
Mailing Address - Phone:952-448-2868
Mailing Address - Fax:
Practice Address - Street 1:1580 WHITE OAK DR
Practice Address - Street 2:SUITE 275
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2919
Practice Address - Country:US
Practice Address - Phone:952-448-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME38291223G0001X
MND121061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice