Healthcare Provider Details

I. General information

NPI: 1013449024
Provider Name (Legal Business Name): DANIEL PATRICK DANSDILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N 22ND ST STE 120
PHOENIX AZ
85016-4962
US

IV. Provider business mailing address

4800 N 22ND ST STE 210
PHOENIX AZ
85016-4963
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-1000
  • Fax: 602-508-4830
Mailing address:
  • Phone: 602-955-1000
  • Fax: 602-508-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2021024751
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number66306
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: