Provider Demographics
NPI:1467652354
Name:DINSMOOR, DANIEL STARK (PH D)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:STARK
Last Name:DINSMOOR
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 SUNSET HILLS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5360
Mailing Address - Country:US
Mailing Address - Phone:703-471-5517
Mailing Address - Fax:
Practice Address - Street 1:11150 SUNSET HILLS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5360
Practice Address - Country:US
Practice Address - Phone:703-471-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical