Healthcare Provider Details

I. General information

NPI: 1982966537
Provider Name (Legal Business Name): CHARLES ZACHARY STAPLES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 PINNACLE PKWY
COVINGTON LA
70433-9193
US

IV. Provider business mailing address

6061 PINNACLE PKWY
COVINGTON LA
70433-9193
US

V. Phone/Fax

Practice location:
  • Phone: 985-327-6501
  • Fax:
Mailing address:
  • Phone: 985-327-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6299
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: