Provider Demographics
NPI:1891910766
Name:MCDANIEL, MARY GRACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:GRACE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-2607
Mailing Address - Country:US
Mailing Address - Phone:903-886-6945
Mailing Address - Fax:903-886-2071
Practice Address - Street 1:1209 MAIN ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-2607
Practice Address - Country:US
Practice Address - Phone:903-886-6945
Practice Address - Fax:903-886-2071
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist