Provider Demographics
NPI:1659988004
Name:DANIELS, ALEXIS HALEY
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:HALEY
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2297 SADIE LN UNIT 226
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7817
Mailing Address - Country:US
Mailing Address - Phone:530-519-7718
Mailing Address - Fax:
Practice Address - Street 1:236 W EAST AVE STE H
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-7239
Practice Address - Country:US
Practice Address - Phone:530-342-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33567124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist