Provider Demographics
NPI:1144890823
Name:STAPLETON, CIARRA (DDS)
Entity type:Individual
Prefix:DR
First Name:CIARRA
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 NW KESSLER DR APT 108
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-4173
Mailing Address - Country:US
Mailing Address - Phone:405-201-6572
Mailing Address - Fax:
Practice Address - Street 1:1125 S 7 HWY
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-3204
Practice Address - Country:US
Practice Address - Phone:816-622-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7426122300000X
MO2021023479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty