Provider Demographics
NPI:1023036316
Name:DANIEL, ANTHONY GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GLENN
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 HAIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2909
Mailing Address - Country:US
Mailing Address - Phone:415-864-5250
Mailing Address - Fax:415-355-0484
Practice Address - Street 1:1344 HAIGHT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2909
Practice Address - Country:US
Practice Address - Phone:415-864-5250
Practice Address - Fax:415-355-0484
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist