Provider Demographics
NPI:1326190364
Name:PHELPS, DANIEL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
Last Name:PHELPS
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 1:2471 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6061
Mailing Address - Country:US
Mailing Address - Phone:910-762-3481
Mailing Address - Fax:910-762-0819
Practice Address - Street 1:2471 DELANEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6061
Practice Address - Country:US
Practice Address - Phone:910-762-3481
Practice Address - Fax:910-762-0819
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice