Provider Demographics
NPI:1962012450
Name:STAGGS, JANE MARIE SMITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE MARIE
Middle Name:SMITH
Last Name:STAGGS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1403 N LOOP 336 W STE C
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3672
Mailing Address - Country:US
Mailing Address - Phone:936-242-4031
Mailing Address - Fax:
Practice Address - Street 1:1403 N LOOP 336 W STE C
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3672
Practice Address - Country:US
Practice Address - Phone:936-242-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70981223G0001X
TX365171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice