Provider Demographics
NPI:1386004141
Name:STALEY, STEPHANIE (DDS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:STALEY
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 1:5211 S MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7861
Mailing Address - Country:US
Mailing Address - Phone:425-892-3456
Mailing Address - Fax:
Practice Address - Street 1:13514 E 32ND AVE # A
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-6002
Practice Address - Country:US
Practice Address - Phone:425-892-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK69391223G0001X
NM390200000X
WA61052144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program