MEDICARE: DR. DAVID WALTER MCDANIEL DMD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4514	NC

General Provider Information

NPI Number	:	1609998897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WALTER MCDANIEL DMD, MPH

Provider Business Mailing Address
First Line	:	1906 MELODY LN
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-4295
Country	:	US
Telephone Number	:	910-509-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 E SAINT JAMES ST
Second Line	:
City	:	TARBORO
State	:	NC
Zip	:	27886-5016
Country	:	US
Telephone Number	:	252-641-7583
Fax Number	:	252-641-7504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	09/26/2013

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