Provider Demographics
NPI:1558701086
Name:MCDANIEL, CHRISTOPHER SHANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 OAKCREST AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1933
Mailing Address - Country:US
Mailing Address - Phone:336-288-0677
Mailing Address - Fax:
Practice Address - Street 1:2516 OAKCREST AVE STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1933
Practice Address - Country:US
Practice Address - Phone:336-288-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214234208600000X, 204E00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC150928OtherDENTAL INTERN PERMIT