Provider Demographics
NPI:1831136902
Name:DANIEL, HAROLD T (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:T
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 C MICHAEL DAVENPORT BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4491
Mailing Address - Country:US
Mailing Address - Phone:502-352-2510
Mailing Address - Fax:502-352-2504
Practice Address - Street 1:103 C MICHAEL DAVENPORT BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4491
Practice Address - Country:US
Practice Address - Phone:502-352-2510
Practice Address - Fax:502-352-2504
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3498122300000X, 1223P0221X, 204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64034986Medicaid
KY60034980Medicaid
KY0047401Medicare PIN
KYT53929Medicare UPIN
KY0997505Medicare PIN
KY0047601Medicare PIN
KY60034980Medicaid
KY0574804Medicare PIN