Healthcare Provider Details

I. General information

NPI: 1215310420
Provider Name (Legal Business Name): DANIEL BRITTON EADDY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 01/16/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 WILD CHERRY DRIVE BLDG. 11
AUSTIN TX
78738
US

IV. Provider business mailing address

3502 WILD CHERRY DRIVE BLDG. 11
AUSTIN TX
78738
US

V. Phone/Fax

Practice location:
  • Phone: 512-263-4252
  • Fax: 512-263-1568
Mailing address:
  • Phone: 512-263-4252
  • Fax: 512-263-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: