Provider Demographics
NPI:1821211319
Name:SOPER, DANIEL MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARTIN
Last Name:SOPER
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 1:1137 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4221
Mailing Address - Country:US
Mailing Address - Phone:417-255-8464
Mailing Address - Fax:417-255-9741
Practice Address - Street 1:1137 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4221
Practice Address - Country:US
Practice Address - Phone:417-255-8464
Practice Address - Fax:417-255-9741
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25631122300000X
MO2009026479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist