MEDICARE: DAN GERALD DANIELS D.D.S.

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	019020284	IL

General Provider Information

NPI Number	:	1407019516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN GERALD DANIELS D.D.S.

Provider Business Mailing Address
First Line	:	938 E ROOSEVELT RD
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3927
Country	:	US
Telephone Number	:	630-231-2442
Fax Number	:	630-231-8544

Provider Business Practice Location Address
First Line	:	938 E ROOSEVELT RD
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3927
Country	:	US
Telephone Number	:	630-231-2442
Fax Number	:	630-231-8544

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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