Provider Demographics
NPI:1164643367
Name:ERIC DANIELS DDS
Entity Type:Organization
Organization Name:ERIC DANIELS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-297-2461
Mailing Address - Street 1:1275 HIGHWAY 93 NORTH
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-0718
Mailing Address - Country:US
Mailing Address - Phone:406-297-2461
Mailing Address - Fax:406-297-2650
Practice Address - Street 1:1275 HIGHWAY 93 NORTH
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-0718
Practice Address - Country:US
Practice Address - Phone:406-297-2461
Practice Address - Fax:406-297-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0113492Medicaid