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General NPI Number Information
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NPI Number | 1487629416
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Entity Type | Individual
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Provider Name | JEFFREY A STAPLES DDS
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 320 B ST BLDG 38H
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City | GREAT LAKES
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State | IL
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Zip | 60088-2815
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Country | US
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Telephone | 847-688-3950
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Fax |
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Provider Business Mailing Address
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Address Line | 185 BOLES LOOP
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City | FORT SHERIDAN
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State | IL
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Zip | 60037-1230
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Country | US
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Telephone | 847-433-0250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-2049
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License Number State | ID
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