Provider Demographics
NPI:1144215914
Name:MAAS, DANIEL JOE (DDS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOE
Last Name:MAAS
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 1:502 4TH ST
Mailing Address - Street 2:PO BOX 665
Mailing Address - City:FULLERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68638-3119
Mailing Address - Country:US
Mailing Address - Phone:308-536-2120
Mailing Address - Fax:308-536-2559
Practice Address - Street 1:502 4TH ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3119
Practice Address - Country:US
Practice Address - Phone:308-536-2120
Practice Address - Fax:308-536-2559
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063510200Medicaid
U66056Medicare UPIN
NE47063510200Medicaid