Provider Demographics
NPI:1326413584
Name:DANIEL J. IANNOTTI, DDS, INC
Entity Type:Organization
Organization Name:DANIEL J. IANNOTTI, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:IANNOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-481-0884
Mailing Address - Street 1:25880 TOURNAMENT RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2349
Mailing Address - Country:US
Mailing Address - Phone:661-481-0884
Mailing Address - Fax:661-481-0443
Practice Address - Street 1:25880 TOURNAMENT RD
Practice Address - Street 2:SUITE 106
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2349
Practice Address - Country:US
Practice Address - Phone:661-481-0884
Practice Address - Fax:661-481-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61318122300000X, 1223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty