Provider Demographics
NPI:1609056860
Name:MCDANIEL, JOHN WILLIAM JR (JOHN MCDANIEL DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:MCDANIEL
Suffix:JR
Gender:M
Credentials:JOHN MCDANIEL DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:WILLIAM
Other - Last Name:MCDANIEL
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:JOHN MCDANIEL
Mailing Address - Street 1:1313 BELTLINE RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149
Mailing Address - Country:US
Mailing Address - Phone:972-289-3330
Mailing Address - Fax:972-226-0367
Practice Address - Street 1:1313 BELTLINE RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:972-289-3330
Practice Address - Fax:972-226-0367
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX152541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice