Provider Demographics
NPI:1346382454
Name:BEKISH, DANIEL J (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:BEKISH
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 RED HAWK CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4106
Mailing Address - Country:US
Mailing Address - Phone:817-294-9200
Mailing Address - Fax:817-370-7065
Practice Address - Street 1:7212 RED HAWK CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4106
Practice Address - Country:US
Practice Address - Phone:817-294-9200
Practice Address - Fax:817-370-7065
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics