MEDICARE: MR. DANIEL MACKENZIE STEGALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN1857943	MA
2	122300000X	Dentist	7772	LA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	1223G0001X	General Practice Dentistry	35751	TX

General Provider Information

NPI Number	:	1023507878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL MACKENZIE STEGALL

Provider Business Mailing Address
First Line	:	7637 LA RISA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75248-4336
Country	:	US
Telephone Number	:	479-597-0151
Fax Number	:

Provider Business Practice Location Address
First Line	:	5757 W LOVERS LN STE 109
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-7115
Country	:	US
Telephone Number	:	214-227-6775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	05/27/2026

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