MEDICARE: DR. MARK MARTIN STAPLETON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3829	ME
2	1223G0001X	General Practice Dentistry	D12106	MN

General Provider Information

NPI Number	:	1497978878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK MARTIN STAPLETON DDS

Provider Business Mailing Address
First Line	:	1580 WHITE OAK DR
Second Line	:	SUITE 275
City	:	CHASKA
State	:	MN
Zip	:	55318-2919
Country	:	US
Telephone Number	:	952-448-2868
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 WHITE OAK DR
Second Line	:	SUITE 275
City	:	CHASKA
State	:	MN
Zip	:	55318-2919
Country	:	US
Telephone Number	:	952-448-2868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	06/08/2011

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