MEDICARE: MCDANIEL ORTHODONTICS, P.C.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS8122	TN

General Provider Information

NPI Number	:	1942510979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCDANIEL ORTHODONTICS, P.C.

Provider Business Mailing Address
First Line	:	951 RIVERFRONT PKWY
Second Line	:	SUITE 202
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-2185
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	951 RIVERFRONT PKWY
Second Line	:	SUITE 202
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-2185
Country	:	US
Telephone Number	:	423-266-8614
Fax Number	:	423-265-0429

Authorized Official
Title or Position	:	SECRETARY
Name	:	DR. ANDREW MCDANIEL
Credential	:	D.D.S., M.S.
Telephone Number	:	423-266-8614

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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