Healthcare Provider Details

I. General information

NPI: 1164489993
Provider Name (Legal Business Name): KENNETH F MCDANIEL DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11499 HIGHLAND RD
HARTLAND MI
48353-2709
US

IV. Provider business mailing address

11499 HIGHLAND RD
HARTLAND MI
48353-2709
US

V. Phone/Fax

Practice location:
  • Phone: 810-632-5566
  • Fax: 810-632-7556
Mailing address:
  • Phone: 810-632-5566
  • Fax: 810-632-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KENNETH F MCDANIEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 810-632-5533