1609056860 NPI number — DR. JOHN WILLIAM MCDANIEL JR. JOHN MCDANIEL D.D.S.

Table of content: DR. JOHN WILLIAM MCDANIEL JR. JOHN MCDANIEL D.D.S. (NPI 1609056860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609056860 NPI number — DR. JOHN WILLIAM MCDANIEL JR. JOHN MCDANIEL D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDANIEL
Provider First Name:
JOHN
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
JOHN MCDANIEL D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDANIEL
Provider Other First Name:
JOHN
Provider Other Middle Name:
WILLIAM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
JOHN MCDANIEL
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1609056860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1313 BELTLINE RD.
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-289-3330
Provider Business Mailing Address Fax Number:
972-226-0367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 BELTLINE RD.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-289-3330
Provider Business Practice Location Address Fax Number:
972-226-0367
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  15254 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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