Healthcare Provider Details

I. General information

NPI: 1568577351
Provider Name (Legal Business Name): LARRY ONEAL STAPLES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 E. CENTENNIAL PARKWAY 110
NORTH LAS VEGAS NV
89081-5605
US

IV. Provider business mailing address

2345 E. CENTENNIAL PARKWAY 110
NORTH LAS VEGAS NV
89081-5605
US

V. Phone/Fax

Practice location:
  • Phone: 702-991-0404
  • Fax: 702-991-0402
Mailing address:
  • Phone: 702-991-0404
  • Fax: 702-991-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number133766
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4667
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: