Provider Demographics
NPI:1447805668
Name:MCDANIEL, PAMELA (RDH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6423 WILLOW PINE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6467
Mailing Address - Country:US
Mailing Address - Phone:281-382-9717
Mailing Address - Fax:
Practice Address - Street 1:16815 SPRING CREEK FOREST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4800
Practice Address - Country:US
Practice Address - Phone:281-370-6911
Practice Address - Fax:281-370-2352
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5991124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist