Provider Demographics
NPI:1710059274
Name:ALTNETHER, DANIEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:ALTNETHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:J
Other - Last Name:ALTNETHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4437 S RIVER BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4658
Mailing Address - Country:US
Mailing Address - Phone:816-350-0400
Mailing Address - Fax:816-350-9989
Practice Address - Street 1:4437 S RIVER BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4658
Practice Address - Country:US
Practice Address - Phone:816-350-0400
Practice Address - Fax:816-350-9989
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO145551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice