=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982812079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ROGERS MCDANIEL D.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2007
-----------------------------------------------------
Last Update Date | 01/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34011 US HIGHWAY 280
-----------------------------------------------------
City | CHILDERSBURG
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35044-2128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-378-3127
-----------------------------------------------------
Fax | 256-378-3501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 354
-----------------------------------------------------
City | CHILDERSBURG
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35044-0354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-378-3127
-----------------------------------------------------
Fax | 256-378-3501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 3351
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------