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NPI Code Detail

MEDICARE: DR. DANIEL L CUSTIS DDS

MEDICARE: DR. DANIEL L CUSTIS 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
11223G0001XGeneral Practice DentistryM-490SD

General Provider Information

NPI Number : 1841214780
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL L CUSTIS DDS
Provider Business Mailing Address
First Line : 141 N 5TH ST
Second Line :
City : CUSTER
State : SD
Zip : 57730-1528
Country : US
Telephone Number : 605-673-2011
Fax Number : 605-673-4529
Provider Business Practice Location Address
First Line : 141 N 5TH ST
Second Line :
City : CUSTER
State : SD
Zip : 57730-1528
Country : US
Telephone Number : 605-673-2011
Fax Number : 605-673-4529
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/08/2007

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Directions to “ DR. DANIEL L CUSTIS DDS” Practice Location

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