1255182267 NPI number — DANIEL DENTISTRY PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255182267 NPI number — DANIEL DENTISTRY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL DENTISTRY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255182267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70887
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44190-0887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-277-3633
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 HIGHWAY 281
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
MARBLE FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-286-3384
Provider Business Practice Location Address Fax Number:
830-286-3386
Provider Enumeration Date:
03/28/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR CONTRACTING
Authorized Official Telephone Number:
315-454-6000

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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