Provider Demographics
NPI:1295830305
Name:MCCAULEY, DANNY PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:PAUL
Last Name:MCCAULEY
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 1:1603 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2329
Mailing Address - Country:US
Mailing Address - Phone:903-572-3981
Mailing Address - Fax:903-577-0643
Practice Address - Street 1:1603 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2329
Practice Address - Country:US
Practice Address - Phone:903-572-3981
Practice Address - Fax:903-577-0643
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084337-02OtherCSHCN I.D. NUMBER
TX0084337-01Medicaid