Provider Demographics
NPI:1790933455
Name:DWYER, DANIEL GUERIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GUERIN
Last Name:DWYER
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 1:15854 JACKSON CREEK PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8662
Mailing Address - Country:US
Mailing Address - Phone:719-302-2200
Mailing Address - Fax:719-302-2205
Practice Address - Street 1:15854 JACKSON CREEK PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8662
Practice Address - Country:US
Practice Address - Phone:719-302-2200
Practice Address - Fax:719-302-2205
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice