Provider Demographics
NPI:1609019926
Name:STALEY, ROBERT JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:STALEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3078 W 7800 S
Mailing Address - Street 2:STE 7-B
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-3707
Mailing Address - Country:US
Mailing Address - Phone:801-280-1911
Mailing Address - Fax:801-255-2394
Practice Address - Street 1:3078 W 7800 S
Practice Address - Street 2:STE 7-B
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-3707
Practice Address - Country:US
Practice Address - Phone:801-280-1911
Practice Address - Fax:801-255-2394
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT37348399221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice