Healthcare Provider Details

I. General information

NPI: 1386850188
Provider Name (Legal Business Name): R. HARRIS DANIEL, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 MCLEANSVILLE RD
MC LEANSVILLE NC
27301-9303
US

IV. Provider business mailing address

5706 MCLEANSVILLE RD
MC LEANSVILLE NC
27301-9303
US

V. Phone/Fax

Practice location:
  • Phone: 336-697-0618
  • Fax: 336-697-9478
Mailing address:
  • Phone: 336-697-0618
  • Fax: 336-697-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4477
License Number StateNC

VIII. Authorized Official

Name: DR. ROBERT HARRIS DANIEL
Title or Position: DENTIST
Credential: DDS
Phone: 336-697-0618