Healthcare Provider Details

I. General information

NPI: 1144221722
Provider Name (Legal Business Name): DANIEL THOMAS NESS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 COX RD
GASTONIA NC
28054-3420
US

IV. Provider business mailing address

1072 X RAY DR
GASTONIA NC
28054-7488
US

V. Phone/Fax

Practice location:
  • Phone: 704-866-7576
  • Fax: 704-866-0106
Mailing address:
  • Phone: 704-671-1094
  • Fax: 704-671-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number9400596
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: