MEDICARE: DANIKA FELLOWS DDS

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	122300000X	Dentist	112661	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1710772967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIKA FELLOWS DDS

Provider Business Mailing Address
First Line	:	36068 HIDDEN SPRINGS RD STE H
Second Line	:
City	:	WILDOMAR
State	:	CA
Zip	:	92595-7681
Country	:	US
Telephone Number	:	951-678-0790
Fax Number	:

Provider Business Practice Location Address
First Line	:	36068 HIDDEN SPRINGS RD STE H
Second Line	:
City	:	WILDOMAR
State	:	CA
Zip	:	92595-7681
Country	:	US
Telephone Number	:	208-241-4089
Fax Number	:

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

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	03/07/2026

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