Provider Demographics
NPI:1467573592
Name:AVANT, DANIEL ADAM (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ADAM
Last Name:AVANT
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:685 CITADEL DR E
Mailing Address - Street 2:#312
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5314
Mailing Address - Country:US
Mailing Address - Phone:719-596-1363
Mailing Address - Fax:719-596-1575
Practice Address - Street 1:685 CITADEL DR E
Practice Address - Street 2:#312
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5314
Practice Address - Country:US
Practice Address - Phone:719-596-1363
Practice Address - Fax:719-596-1575
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics