Provider Demographics
NPI:1588600712
Name:DUGAN, DANIEL J (DDS OMS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:DUGAN
Suffix:
Gender:M
Credentials:DDS OMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 HARWOOD RD WEST
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3161
Mailing Address - Country:US
Mailing Address - Phone:817-268-4108
Mailing Address - Fax:817-282-2479
Practice Address - Street 1:613 HARWOOD RD WEST
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3161
Practice Address - Country:US
Practice Address - Phone:817-268-4108
Practice Address - Fax:817-282-2479
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD11932122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13078Medicare ID - Type Unspecified
T13078Medicare UPIN