Provider Demographics
NPI:1659339091
Name:YOHANNES, DANIEL HAILE MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HAILE MICHAEL
Last Name:YOHANNES
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 1:602 W UNION HILLS DR
Mailing Address - Street 2:STE #8
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-6629
Mailing Address - Country:US
Mailing Address - Phone:623-516-7766
Mailing Address - Fax:623-516-7788
Practice Address - Street 1:602 W UNION HILLS DR
Practice Address - Street 2:STE #8
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-6629
Practice Address - Country:US
Practice Address - Phone:623-516-7766
Practice Address - Fax:623-516-7788
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0419710OtherBCBS
AZ1563763OtherUNITED CONCORDIA
AZ955148OtherAHCCCS