Provider Demographics
NPI:1659122711
Name:MCERLEAN, DANIEL CONNOR
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CONNOR
Last Name:MCERLEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:CONNOR
Other - Last Name:MCERLEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MHS
Mailing Address - Street 1:43 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4209
Mailing Address - Country:US
Mailing Address - Phone:845-492-0990
Mailing Address - Fax:
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program