Provider Demographics
NPI:1790897064
Name:STAPLES DENTAL CARE
Entity Type:Organization
Organization Name:STAPLES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:FAGD
Authorized Official - Phone:435-673-9606
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84771-0008
Mailing Address - Country:US
Mailing Address - Phone:435-673-9606
Mailing Address - Fax:435-673-6812
Practice Address - Street 1:427 W 100 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3375
Practice Address - Country:US
Practice Address - Phone:435-673-9606
Practice Address - Fax:435-673-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty