MEDICARE: DANIEL HOSTRANDER

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	10016	NC

General Provider Information

NPI Number	:	1942689294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL HOSTRANDER

Provider Business Mailing Address
First Line	:	114 KILEY ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-6079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3747 LATROBE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1164
Country	:	US
Telephone Number	:	607-372-7460
Fax Number	:

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/30/2015

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Directions to “ DANIEL HOSTRANDER ” Practice Location

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