Provider Demographics
NPI:1619004017
Name:DANIELS, ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 US HIGHWAY 93 N
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-9054
Mailing Address - Country:US
Mailing Address - Phone:406-297-2461
Mailing Address - Fax:406-297-2650
Practice Address - Street 1:744 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9054
Practice Address - Country:US
Practice Address - Phone:406-297-2461
Practice Address - Fax:406-297-2650
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1164643367Medicaid