Provider Demographics
NPI:1770663494
Name:DORMAN, DANIEL DALLAS (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DALLAS
Last Name:DORMAN
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3094
Mailing Address - Country:US
Mailing Address - Phone:810-664-8481
Mailing Address - Fax:
Practice Address - Street 1:3620 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-8966
Practice Address - Country:US
Practice Address - Phone:810-664-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1128701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice