Provider Demographics
NPI:1922186253
Name:DANTINI, DANIEL CHARLES JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHARLES
Last Name:DANTINI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 OLD KINGS RD N
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8231
Mailing Address - Country:US
Mailing Address - Phone:386-446-2202
Mailing Address - Fax:386-597-2975
Practice Address - Street 1:29 OLD KINGS RD N
Practice Address - Street 2:SUITE 6A
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8231
Practice Address - Country:US
Practice Address - Phone:386-446-2202
Practice Address - Fax:386-597-2975
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15778207Y00000X
FLME 0015778207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062696100Medicaid
FL08787Medicare PIN
FL062696100Medicaid