=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528844180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAN DANIELS, DDS A PROFESSIONAL COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2023
-----------------------------------------------------
Last Update Date | 09/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9750 MIRAMAR RD STE 375
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92126-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-635-9569
-----------------------------------------------------
Fax | 858-635-6747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9750 MIRAMAR RD STE 375
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92126-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-635-9569
-----------------------------------------------------
Fax | 858-635-6747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | SEAN DANIELS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 858-635-9569
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------