Healthcare Provider Details

I. General information

NPI: 1245461110
Provider Name (Legal Business Name): KRISTINA DIANE STAPLES DDS.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 10/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 NORTH MAIN ST
BLACKSTONE VA
23824-1029
US

IV. Provider business mailing address

551 NORTH MAIN ST
BLACKSTONE VA
23824-1029
US

V. Phone/Fax

Practice location:
  • Phone: 434-292-5318
  • Fax: 434-264-3121
Mailing address:
  • Phone: 434-292-5318
  • Fax: 434-264-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401412560
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: