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General NPI Number Information
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NPI Number | 1699903567
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Entity Type | Organization
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Legal Business Name | DANIELLE S. EZELL, DMD, PA
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 9 W MADISON ST
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City | YORK
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State | SC
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Zip | 29745-1143
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Country | US
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Telephone | 803-684-6545
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Fax | 803-684-0239
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Provider Business Mailing Address
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Address Line | PO BOX 395
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City | YORK
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State | SC
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Zip | 29745-0395
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Country | US
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Telephone | 803-684-6545
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Fax | 803-684-0239
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. DANIELLE SUZETTE EZELL
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Credential | DMD
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Telephone | 803-684-6545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4367
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License Number State | SC
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