Provider Demographics
NPI:1639358401
Name:DANIEL, PATRICK CARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CARL
Last Name:DANIEL
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 1:127 W MACON LN STE 1
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4776
Mailing Address - Country:US
Mailing Address - Phone:865-573-7330
Mailing Address - Fax:
Practice Address - Street 1:127 W MACON LN STE 1
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4776
Practice Address - Country:US
Practice Address - Phone:865-573-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000009638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist