Provider Demographics
NPI:1710241807
Name:WEST, DANIEL ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:WEST
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 1:895 SUMMERS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4852
Mailing Address - Country:US
Mailing Address - Phone:803-308-2063
Mailing Address - Fax:
Practice Address - Street 1:895 SUMMERS AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4852
Practice Address - Country:US
Practice Address - Phone:803-534-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD 80931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice