Healthcare Provider Details

I. General information

NPI: 1033696406
Provider Name (Legal Business Name): DANIEL E NIEMANN DDS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 HUNTINGTON DR STE B
SOUTH PASADENA CA
91030-4900
US

IV. Provider business mailing address

2050 HUNTINGTON DR STE B
SOUTH PASADENA CA
91030-4900
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-2331
  • Fax: 626-441-2341
Mailing address:
  • Phone: 626-441-2331
  • Fax: 626-441-2341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL E NIEMANN
Title or Position: OWNER / SURGEON
Credential: DDS
Phone: 626-441-2331