Healthcare Provider Details

I. General information

NPI: 1053671131
Provider Name (Legal Business Name): DOUGLAS S. DANIELS, D.M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E WHITTIER BLVD
LA HABRA CA
90631-3929
US

IV. Provider business mailing address

640 E WHITTIER BLVD
LA HABRA CA
90631-3929
US

V. Phone/Fax

Practice location:
  • Phone: 562-694-3660
  • Fax: 562-690-6181
Mailing address:
  • Phone: 562-694-3660
  • Fax: 562-690-6181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number36352
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number54935
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number53060
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number42096
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number69076
License Number StateCA

VIII. Authorized Official

Name: DR. DOUGLAS STEVEN DANIELS
Title or Position: OWNER
Credential: D.M.D.
Phone: 562-694-3660