Provider Demographics
NPI:1134312499
Name:DANIELS, SAMUEL (DDS MS PLLC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DDS MS PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1525
Mailing Address - Country:US
Mailing Address - Phone:810-229-2776
Mailing Address - Fax:810-229-8080
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1525
Practice Address - Country:US
Practice Address - Phone:810-229-2776
Practice Address - Fax:810-229-8080
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0142931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics