Provider Demographics
NPI:1750906814
Name:STAPLES, RYANE (DMD)
Entity type:Individual
Prefix:
First Name:RYANE
Middle Name:
Last Name:STAPLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1921
Mailing Address - Country:US
Mailing Address - Phone:662-327-2100
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL DR STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1921
Practice Address - Country:US
Practice Address - Phone:662-327-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4464-241223S0112X
TX37297390200000X
MSOS-6067-24204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program