Provider Demographics
NPI:1134552995
Name:HISEROTE, DANIEL DAVID JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DAVID
Last Name:HISEROTE
Suffix:JR
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 1:1629 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1120
Mailing Address - Country:US
Mailing Address - Phone:712-722-3216
Mailing Address - Fax:712-722-3218
Practice Address - Street 1:1629 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1120
Practice Address - Country:US
Practice Address - Phone:712-722-3216
Practice Address - Fax:712-722-3218
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-090481223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics