Healthcare Provider Details

I. General information

NPI: 1194402958
Provider Name (Legal Business Name): DANIEL SYRIANOS-ROBERTSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAIN ST
LAUREL MD
20707-4335
US

IV. Provider business mailing address

173 S 32ND ST
CAMP HILL PA
17011-5102
US

V. Phone/Fax

Practice location:
  • Phone: 301-490-0044
  • Fax:
Mailing address:
  • Phone: 717-761-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18966
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS044201
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4712
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: