=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740175728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAUSHEEN PEARL DANIEL DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2025
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3131 MILTON AVE STE 190
-----------------------------------------------------
City | JANESVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53545-0244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-302-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 741 MYRTLE WAY APT 213
-----------------------------------------------------
City | JANESVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53545-9120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-358-1969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6001845-15
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------