Provider Demographics
NPI:1568577351
Name:STAPLES, LARRY ONEAL (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ONEAL
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 1:2345 E. CENTENNIAL PARKWAY
Mailing Address - Street 2:110
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-5605
Mailing Address - Country:US
Mailing Address - Phone:702-991-0404
Mailing Address - Fax:702-991-0402
Practice Address - Street 1:2345 E. CENTENNIAL PARKWAY
Practice Address - Street 2:110
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-5605
Practice Address - Country:US
Practice Address - Phone:702-991-0404
Practice Address - Fax:702-991-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133766122300000X
NV4667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4667OtherNEVADA STATE BOARD OF DENTISTRY