Healthcare Provider Details

I. General information

NPI: 1962394312
Provider Name (Legal Business Name): MARK STAPLETON DMD, MSD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2991 HILYARD ST
EUGENE OR
97405-3717
US

IV. Provider business mailing address

2991 HILYARD ST
EUGENE OR
97405-3717
US

V. Phone/Fax

Practice location:
  • Phone: 541-736-5525
  • Fax:
Mailing address:
  • Phone: 541-736-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARK STAPLETON
Title or Position: PRESIDENT
Credential: DMD, MSD
Phone: 541-736-5525