Provider Demographics
NPI:1104045863
Name:DANIEL, KATHRYN MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARIE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 S SYLVAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9049
Mailing Address - Country:US
Mailing Address - Phone:407-688-0293
Mailing Address - Fax:
Practice Address - Street 1:120 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE #264
Practice Address - City:HEATHROW
Practice Address - State:FL
Practice Address - Zip Code:32746-5031
Practice Address - Country:US
Practice Address - Phone:407-333-2113
Practice Address - Fax:407-333-2445
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist