MEDICARE: CHRISTOPHER SEAN DANIEL DDS, MD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	23159	TX

General Provider Information

NPI Number	:	1285899211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER SEAN DANIEL DDS, MD

Provider Business Mailing Address
First Line	:	1174 MONTGOMERY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4802
Country	:	US
Telephone Number	:	707-545-4625
Fax Number	:	707-545-4940

Provider Business Practice Location Address
First Line	:	1174 MONTGOMERY DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-4802
Country	:	US
Telephone Number	:	707-545-4625
Fax Number	:	707-545-4940

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

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	07/18/2008

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