Provider Demographics
NPI:1194749358
Name:STATON, RICHARD ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:STATON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 S 51ST CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3669
Mailing Address - Country:US
Mailing Address - Phone:479-452-1738
Mailing Address - Fax:479-452-2145
Practice Address - Street 1:2420 S 51ST CT
Practice Address - Street 2:SUITE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3669
Practice Address - Country:US
Practice Address - Phone:479-452-1738
Practice Address - Fax:479-452-2145
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice