Healthcare Provider Details

I. General information

NPI: 1639342256
Provider Name (Legal Business Name): MCDANIEL ORTHODONTICS OF CLEVELAND, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 OCOEE ST N SUITE 2
CLEVELAND TN
37312-4885
US

IV. Provider business mailing address

4160 OCOEE ST N SUITE 2
CLEVELAND TN
37312-4885
US

V. Phone/Fax

Practice location:
  • Phone: 423-472-9930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS8122
License Number StateTN

VIII. Authorized Official

Name: DR. ANDREW MCDANIEL
Title or Position: ORTHODONTIST
Credential: DDS, MS
Phone: 423-472-9930