Provider Demographics
NPI:1609998897
Name:MCDANIEL, DAVID WALTER (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WALTER
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4295
Mailing Address - Country:US
Mailing Address - Phone:910-509-0096
Mailing Address - Fax:
Practice Address - Street 1:122 E SAINT JAMES ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5016
Practice Address - Country:US
Practice Address - Phone:252-641-7583
Practice Address - Fax:252-641-7504
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist