Healthcare Provider Details

I. General information

NPI: 1790870889
Provider Name (Legal Business Name): DANIEL P MOYLAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10711 N STRAITS HWY
CHEBOYGAN MI
49721-9077
US

IV. Provider business mailing address

10711 N STRAITS HWY PO BOX 5215
CHEBOYGAN MI
49721-9077
US

V. Phone/Fax

Practice location:
  • Phone: 989-732-4199
  • Fax:
Mailing address:
  • Phone: 231-637-9352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: