Individual provider Active NPI

Robert Joseph Staley, D.M.D

  • General Practice Dentistry
  • West Jordan, UT
National Provider Identifier
1609019926
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3734839922 Issued in UT
Practice address
3078 W 7800 S
Ste 7-B
West Jordan, UT 84088-3707
Phone
(801) 280-1911
Fax
(801) 255-2394
NPI assigned
Apr 16, 2009
Last updated
Dec 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3734839922 UT Primary

Addresses

Primary practice location

3078 W 7800 S
Ste 7-B
West Jordan, UT 84088-3707

Mailing address

3078 W 7800 S
Ste 7-B
West Jordan, UT 84088-3707
Phone (801) 280-1911

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rstaley749032@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160427001046 UT Order and Referring Only - DentistPractitioner - Dentist 7517266497

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3734839922UTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Copper Creek Dental, PC General Practice Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: rstaley749032@direct.med.utah.edu

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1609019926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3078 W 7800 S",
            "address_2": "STE 7-B",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840883707",
            "telephone_number": "801-280-1911",
            "fax_number": "801-255-2394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3078 W 7800 S",
            "address_2": "STE 7-B",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840883707",
            "telephone_number": "801-280-1911",
            "fax_number": "801-255-2394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-16",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "3734839922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rstaley749032@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Jordan, UT

Sources for this page

Verify at the official NPI Registry.