Provider Demographics
NPI:1790870889
Name:MOYLAN, DANIEL P (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:MOYLAN
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 1:10711 N STRAITS HWY
Mailing Address - Street 2:PO BOX 5215
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-9077
Mailing Address - Country:US
Mailing Address - Phone:231-637-9352
Mailing Address - Fax:
Practice Address - Street 1:10711 N STRAITS HWY
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-9077
Practice Address - Country:US
Practice Address - Phone:989-732-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI19359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist