Provider Demographics
NPI:1922458918
Name:DANIELS, ZACHARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:DANIELS
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 1:22763 RUMOR LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2517
Mailing Address - Country:US
Mailing Address - Phone:603-219-6958
Mailing Address - Fax:
Practice Address - Street 1:6958 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-1618
Practice Address - Country:US
Practice Address - Phone:573-596-4931
Practice Address - Fax:573-596-0198
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04229122300000X
MO20210142281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist