Provider Demographics
NPI:1083773493
Name:DANIELS, GREGORY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:DANIELS
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 1:950 N YORK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2950
Mailing Address - Country:US
Mailing Address - Phone:630-655-8815
Mailing Address - Fax:630-655-8813
Practice Address - Street 1:950 N YORK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2950
Practice Address - Country:US
Practice Address - Phone:630-655-8815
Practice Address - Fax:630-655-8813
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice