Provider Demographics
NPI:1639342256
Name:MCDANIEL ORTHODONTICS OF CLEVELAND, P.C.
Entity Type:Organization
Organization Name:MCDANIEL ORTHODONTICS OF CLEVELAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:423-472-9930
Mailing Address - Street 1:4160 OCOEE ST N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4885
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4160 OCOEE ST N
Practice Address - Street 2:SUITE 2
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4885
Practice Address - Country:US
Practice Address - Phone:423-472-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCDANIEL ORTHODONTICS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS81221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty