Provider Demographics
NPI:1710159579
Name:DANEL, JEREMIAH KIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:KIM
Last Name:DANEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 32ND AVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-775-0684
Mailing Address - Fax:701-775-3282
Practice Address - Street 1:2650 32ND AVE SOUTH
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-775-0684
Practice Address - Fax:701-775-3282
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND20431223X0400X
MND124901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics