Provider Demographics
NPI:1588672224
Name:MCDANIEL, JOY NATASHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:NATASHA
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:NATASHA
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:10726 MANOR CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2752
Mailing Address - Country:US
Mailing Address - Phone:210-598-9483
Mailing Address - Fax:
Practice Address - Street 1:10726 MANOR CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2752
Practice Address - Country:US
Practice Address - Phone:210-598-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0360881223G0001X
NC83231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1588672224Medicaid