Provider Demographics
NPI:1205032059
Name:DANIELS, BRIAN J (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W THOMAS RD STE 490
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4239
Mailing Address - Country:US
Mailing Address - Phone:602-265-8751
Mailing Address - Fax:602-266-1155
Practice Address - Street 1:500 W THOMAS RD STE 490
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4239
Practice Address - Country:US
Practice Address - Phone:602-265-8751
Practice Address - Fax:602-266-1155
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice