Provider Demographics
NPI:1053671131
Name:DOUGLAS S. DANIELS, D.M.D. INC.
Entity Type:Organization
Organization Name:DOUGLAS S. DANIELS, D.M.D. INC.
Other - Org Name:DANIELS DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-694-3660
Mailing Address - Street 1:640 E WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3929
Mailing Address - Country:US
Mailing Address - Phone:562-694-3660
Mailing Address - Fax:562-690-6181
Practice Address - Street 1:640 E WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3929
Practice Address - Country:US
Practice Address - Phone:562-694-3660
Practice Address - Fax:562-690-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36352122300000X
CA549351223E0200X
CA530601223S0112X
CA42096126800000X
CA69076126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty