Provider Demographics
NPI:1033696406
Name:DANIEL E NIEMANN DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:DANIEL E NIEMANN DDS DENTAL CORPORATION
Other - Org Name:HUNTINGTON ORAL SURGERY AND IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-441-2331
Mailing Address - Street 1:2050 HUNTINGTON DR STE B
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4900
Mailing Address - Country:US
Mailing Address - Phone:626-441-2331
Mailing Address - Fax:626-441-2341
Practice Address - Street 1:2050 HUNTINGTON DR STE B
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4900
Practice Address - Country:US
Practice Address - Phone:626-441-2331
Practice Address - Fax:626-441-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery