=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144890823
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CIARRA STAPLETON DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2021
-----------------------------------------------------
Last Update Date | 07/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1125 S 7 HWY
-----------------------------------------------------
City | BLUE SPRINGS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64014-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-622-1029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 NW KESSLER DR APT 108
-----------------------------------------------------
City | LEES SUMMIT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64081-4173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-201-6572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7426
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2021023479
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------