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General NPI Number Information
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NPI Number | 1649967068
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Entity Type | Individual
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Provider Name | NICOLAS SHANE STAPLETON DMD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 2255 N UNIVERSITY PKWY STE 37
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City | PROVO
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State | UT
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Zip | 84604-1503
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Country | US
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Telephone | 801-386-8778
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 S 750 W
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City | AMERICAN FORK
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State | UT
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Zip | 84003-4541
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Country | US
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Telephone | 949-633-9994
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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 | 13357463-9923
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License Number State | UT
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