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General NPI Number Information
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NPI Number | 1760812556
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Entity Type | Organization
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Legal Business Name | RICHARD J STALLER DDS PA
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 15340 JOG ROAD SUITE 100
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City | DELRAY BEACH
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State | FL
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Zip | 33446-6537
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Country | US
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Telephone | 561-495-2099
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Fax |
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Provider Business Mailing Address
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Address Line | 15340 JOG ROAD SUITE 100
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City | DELRAY BEACH
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State | FL
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Zip | 33446-6537
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Country | US
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Telephone | 561-495-2099
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KELLI N CARTER
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Credential |
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Telephone | 561-495-2099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9191
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 6099
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 10823
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9129
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License Number State | FL
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