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General NPI Number Information
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NPI Number | 1053671131
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Entity Type | Organization
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Legal Business Name | DOUGLAS S. DANIELS, D.M.D. INC.
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 640 E WHITTIER BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-3929
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Country | US
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Telephone | 562-694-3660
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Fax | 562-690-6181
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Provider Business Mailing Address
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Address Line | 640 E WHITTIER BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-3929
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Country | US
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Telephone | 562-694-3660
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Fax | 562-690-6181
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOUGLAS STEVEN DANIELS
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Credential | D.M.D.
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Telephone | 562-694-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 54935
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 53060
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 42096
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 69076
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36352
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License Number State | CA
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