Provider Demographics
NPI:1851609655
Name:DANIEL A. AVANT DDS MSD PC
Entity Type:Organization
Organization Name:DANIEL A. AVANT DDS MSD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:AVANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-596-1363
Mailing Address - Street 1:685 CITADEL DR E
Mailing Address - Street 2:SUITE 312
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5314
Mailing Address - Country:US
Mailing Address - Phone:719-596-1363
Mailing Address - Fax:719-596-1571
Practice Address - Street 1:685 CITADEL DR E
Practice Address - Street 2:SUITE 312
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5314
Practice Address - Country:US
Practice Address - Phone:719-596-1363
Practice Address - Fax:719-596-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1467573592OtherTYPE I