Provider Demographics
NPI:1023417193
Name:STALLER DENTAL & ASSOCIATES
Entity type:Organization
Organization Name:STALLER DENTAL & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:STALLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-637-9300
Mailing Address - Street 1:5869 W ATLANTIC AVE
Mailing Address - Street 2:SUITE A2A
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8402
Mailing Address - Country:US
Mailing Address - Phone:561-637-9300
Mailing Address - Fax:561-637-1718
Practice Address - Street 1:5869 W ATLANTIC AVE
Practice Address - Street 2:SUITE A2A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8402
Practice Address - Country:US
Practice Address - Phone:561-637-9300
Practice Address - Fax:561-637-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN7779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty