Provider Demographics
NPI:1104908714
Name:STAPP, BRIAN DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:STAPP
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 1:11970 WILCREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-1923
Mailing Address - Country:US
Mailing Address - Phone:281-933-9950
Mailing Address - Fax:281-933-9953
Practice Address - Street 1:11970 WILCREST DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-1923
Practice Address - Country:US
Practice Address - Phone:281-933-9950
Practice Address - Fax:281-933-9953
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16399OtherSTATE LICENSE #
TX5395637OtherAETNA PROVIDER ID#
TX86D552OtherBC/BS PROVIDER#
TX86D552OtherBC/BS PROVIDER#
TX00961WMedicare ID - Type UnspecifiedMEDICARE GROUP #
TXU70881Medicare UPIN