Provider Demographics
NPI:1851505911
Name:MASCIANTONIO, DANIEL V (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:V
Last Name:MASCIANTONIO
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 1:22633 HOLLAND SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619
Mailing Address - Country:US
Mailing Address - Phone:410-535-5055
Mailing Address - Fax:
Practice Address - Street 1:230 W DARES BEACH RD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3150
Practice Address - Country:US
Practice Address - Phone:410-535-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD85831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice