MEDICARE: STAPLEY DENTAL GROUP, PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1972692721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAPLEY DENTAL GROUP, PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2860 MICHELLE
Second Line	:	2ND FLOOR
City	:	IRVINE
State	:	CA
Zip	:	92606-1009
Country	:	US
Telephone Number	:	714-508-3600
Fax Number	:	714-368-2092

Provider Business Practice Location Address
First Line	:	1920 S STAPLEY DR
Second Line	:	STE. 105
City	:	MESA
State	:	AZ
Zip	:	85204-6678
Country	:	US
Telephone Number	:	480-545-5300
Fax Number	:	480-545-5303

Authorized Official
Title or Position	:	OWNER DDS
Name	:	DR. BRIAN D BUEHLER
Credential	:	DDS
Telephone Number	:	480-545-5300

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	06/03/2009

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