=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578782413
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRED DANZIGER DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 11/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 WEST PARK AVE
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11561-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-432-2837
-----------------------------------------------------
Fax | 516-432-6319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 234 SEVEN FARMS DR
-----------------------------------------------------
City | DANIEL ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29492-8107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-284-4444
-----------------------------------------------------
Fax | 843-377-8499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4277
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------