Provider Demographics
NPI:1740382118
Name:STAPLES, RONALD CARLTON (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:CARLTON
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 1:1251 WESLEY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6425
Mailing Address - Country:US
Mailing Address - Phone:901-398-0793
Mailing Address - Fax:901-398-0222
Practice Address - Street 1:1251 WESLEY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6425
Practice Address - Country:US
Practice Address - Phone:901-398-0793
Practice Address - Fax:901-398-0222
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS47251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225352Medicare ID - Type Unspecified
TNU49355Medicare UPIN