Provider Demographics
NPI:1548594161
Name:DANIEL, KANIKA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:KANIKA
Middle Name:S
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KANIKA
Other - Middle Name:S
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4624 W BAILEY BOSWELL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-4320
Mailing Address - Country:US
Mailing Address - Phone:817-203-1084
Mailing Address - Fax:
Practice Address - Street 1:4624 W BAILEY BOSWELL RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-4320
Practice Address - Country:US
Practice Address - Phone:817-203-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6450-15122300000X
TX0024974122300000X
TX249741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist