Healthcare Provider Details

I. General information

NPI: 1003887050
Provider Name (Legal Business Name): DANIEL JAY NEUMANN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 MAIN ST
WRAY CO
80758-1725
US

IV. Provider business mailing address

416 MAIN ST
WRAY CO
80758-1725
US

V. Phone/Fax

Practice location:
  • Phone: 970-332-4817
  • Fax: 970-332-4074
Mailing address:
  • Phone: 970-332-4817
  • Fax: 970-332-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6158
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: