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General NPI Number Information
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NPI Number | 1467560136
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Entity Type | Individual
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Provider Name | MARK E DANIELS DMD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | BLDG 6 3237 ROUTE 112 SUITE 7B
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City | MEDFORD
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State | NY
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Zip | 11763-1424
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Country | US
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Telephone | 631-698-1140
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Fax | 631-696-3520
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Provider Business Mailing Address
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Address Line | BLDG 6 3237 ROUTE 112 SUITE 7B
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City | MEDFORD
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State | NY
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Zip | 11763-1424
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Country | US
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Telephone | 631-698-1140
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Fax | 631-696-3520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 041644-1
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License Number State | NY
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