MEDICARE: DR. THOMAS RYAN DANIEL DDS

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	1223G0001X	General Practice Dentistry	5946	OK
2	1223G0001X	General Practice Dentistry	24047	TX

General Provider Information

NPI Number	:	1649475443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS RYAN DANIEL DDS

Provider Business Mailing Address
First Line	:	4302 WAKEFIELD CT
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072
Country	:	US
Telephone Number	:	405-401-6820
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 ROUTH ST
Second Line	:	SUITE 310
City	:	DALLAS
State	:	TX
Zip	:	75201-1462
Country	:	US
Telephone Number	:	405-401-6820
Fax Number	:

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

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	06/02/2009

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