Provider Demographics
NPI:1790073161
Name:KWAN, DARYL ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:ANTHONY
Last Name:KWAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W OAKLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4033
Mailing Address - Country:US
Mailing Address - Phone:830-569-8940
Mailing Address - Fax:830-569-8527
Practice Address - Street 1:310 W OAKLAWN RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4033
Practice Address - Country:US
Practice Address - Phone:830-569-2527
Practice Address - Fax:830-569-8538
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX272011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27201OtherDENTAL LICENSE
TX27201OtherDENTAL LICENSE