Healthcare Provider Details

I. General information

NPI: 1154673341
Provider Name (Legal Business Name): DAVID DANIEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 BANCROFT RD
BALTIMORE MD
21215-3229
US

IV. Provider business mailing address

3617 BANCROFT RD
BALTIMORE MD
21215-3229
US

V. Phone/Fax

Practice location:
  • Phone: 646-509-4138
  • Fax:
Mailing address:
  • Phone: 646-509-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15214
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15214
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: