Provider Demographics
NPI:1992046023
Name:BYTHEWOOD, DANIEL WALLACE (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WALLACE
Last Name:BYTHEWOOD
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:SUITE L-19
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5806
Mailing Address - Country:US
Mailing Address - Phone:516-248-2560
Mailing Address - Fax:516-248-2590
Practice Address - Street 1:520 FRANKLIN AVE
Practice Address - Street 2:SUITE L-19
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5806
Practice Address - Country:US
Practice Address - Phone:516-248-2560
Practice Address - Fax:516-248-2590
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics