Provider Demographics
NPI:1710202668
Name:FANIKOS, DANIEL P (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:FANIKOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ALFRED ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1976
Mailing Address - Country:US
Mailing Address - Phone:781-933-8380
Mailing Address - Fax:781-933-8381
Practice Address - Street 1:7 ALFRED ST
Practice Address - Street 2:SUITE 125
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1976
Practice Address - Country:US
Practice Address - Phone:781-933-8380
Practice Address - Fax:781-933-8381
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1855237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1855237OtherSTATE DENTAL LICENCE