Provider Demographics
NPI:1245461110
Name:STAPLES, KRISTINA DIANE (DDS)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DIANE
Last Name:STAPLES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-1029
Mailing Address - Country:US
Mailing Address - Phone:434-292-5318
Mailing Address - Fax:434-264-3121
Practice Address - Street 1:551 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-1029
Practice Address - Country:US
Practice Address - Phone:434-292-5318
Practice Address - Fax:434-264-3121
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412560122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist