Provider Demographics
NPI:1639267024
Name:DANIELS, VINCENT JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JAMES
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1392
Mailing Address - Country:US
Mailing Address - Phone:302-655-8387
Mailing Address - Fax:302-654-7162
Practice Address - Street 1:2300 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 2-C
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1392
Practice Address - Country:US
Practice Address - Phone:302-655-8387
Practice Address - Fax:302-654-7162
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021630Medicaid