Provider Demographics
NPI:1588217202
Name:HANFORD, DANIELLE NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:NICOLE
Last Name:HANFORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:GRIFFIN
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:13720 OLD SAINT AUGUSTINE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-7415
Mailing Address - Country:US
Mailing Address - Phone:904-292-1002
Mailing Address - Fax:
Practice Address - Street 1:13720 OLD SAINT AUGUSTINE RD STE 5
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7415
Practice Address - Country:US
Practice Address - Phone:904-292-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015917122300000X
FLDN28738122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist