Provider Demographics
NPI:1245203041
Name:ESCALANTE, DANIEL DEJESUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DEJESUS
Last Name:ESCALANTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8148 S WABASH CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3329
Mailing Address - Country:US
Mailing Address - Phone:617-504-0420
Mailing Address - Fax:702-995-4193
Practice Address - Street 1:19700 E PARKER SQUARE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7301
Practice Address - Country:US
Practice Address - Phone:303-840-2300
Practice Address - Fax:702-995-4193
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002025151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty