Active NPI
Robert W Staley Jr., DDS
- Dentist
- Salem, OR
National Provider Identifier
1679632509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5100
- Practice address
- 4372 Liberty Rd S
Salem, OR 97302 - Phone
- (503) 581-3727
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5100 | OR | Primary |
Addresses
Primary practice location
4372 Liberty Rd S
Salem, OR 97302
Mailing address
4372 Liberty Rd S
Salem, OR 97302
Phone (503) 581-3727
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 182899 | Other | OR | OMAP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5100 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679632509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4372 LIBERTY RD S",
"city": "SALEM",
"state": "OR",
"postal_code": "97302",
"telephone_number": "503-581-3727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4372 LIBERTY RD S",
"city": "SALEM",
"state": "OR",
"postal_code": "97302",
"telephone_number": "503-581-3727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STALEY",
"first_name": "ROBERT",
"middle_name": "W",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "5100",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OMAP",
"identifier": "182899",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.