Provider Demographics
NPI:1821218314
Name:SCOW, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SCOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 W RAY RD
Mailing Address - Street 2:STE 17
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-6108
Mailing Address - Country:US
Mailing Address - Phone:480-893-2695
Mailing Address - Fax:
Practice Address - Street 1:5055 W RAY RD
Practice Address - Street 2:STE 17
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-6108
Practice Address - Country:US
Practice Address - Phone:480-893-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5688124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist