Provider Demographics
NPI:1013052760
Name:DESILETS, DANIEL LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LAWRENCE
Last Name:DESILETS
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 1:602 E CAMPBELL
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:TX
Mailing Address - Zip Code:79745
Mailing Address - Country:US
Mailing Address - Phone:432-586-3477
Mailing Address - Fax:432-586-2664
Practice Address - Street 1:602 E CAMPBELL
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:TX
Practice Address - Zip Code:79745
Practice Address - Country:US
Practice Address - Phone:432-586-3477
Practice Address - Fax:432-586-2664
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice