Provider Demographics
NPI:1558550707
Name:STAPLES, RANDALL P (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:P
Last Name:STAPLES
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 1:3021 HIGHWAY 45 BYP
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-0602
Mailing Address - Country:US
Mailing Address - Phone:731-668-6700
Mailing Address - Fax:731-668-9383
Practice Address - Street 1:3021 HIGHWAY 45 BYP
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-0602
Practice Address - Country:US
Practice Address - Phone:731-668-6700
Practice Address - Fax:731-668-9383
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist