Provider Demographics
NPI:1942335401
Name:DANIELS, ALLEN DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DALE
Last Name:DANIELS
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 1:24173 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025
Mailing Address - Country:US
Mailing Address - Phone:812-656-8888
Mailing Address - Fax:812-656-8016
Practice Address - Street 1:24173 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-656-8888
Practice Address - Fax:812-656-8016
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022681122300000X
TNDS26771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice