Provider Demographics
NPI:1871648790
Name:WARK, DANIEL PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PETER
Last Name:WARK
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 1:209 RUSHLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5514
Mailing Address - Country:US
Mailing Address - Phone:610-459-2855
Mailing Address - Fax:610-459-2855
Practice Address - Street 1:801 YALE AVE STE 620
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1811
Practice Address - Country:US
Practice Address - Phone:610-543-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-017465-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice