Healthcare Provider Details

I. General information

NPI: 1982084513
Provider Name (Legal Business Name): DANIEL MORIN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S 4J RD
GILLETTE WY
82716-4132
US

IV. Provider business mailing address

805 S 4J RD
GILLETTE WY
82716-4132
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-5665
  • Fax:
Mailing address:
  • Phone: 307-686-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number929
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: