Provider Demographics
NPI:1184982548
Name:UNZICKER, DANIEL WESLEY
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WESLEY
Last Name:UNZICKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 N DOUTY ST STE B
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3983
Mailing Address - Country:US
Mailing Address - Phone:559-584-2777
Mailing Address - Fax:559-585-8764
Practice Address - Street 1:912 N DOUTY ST STE B
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3983
Practice Address - Country:US
Practice Address - Phone:559-584-2777
Practice Address - Fax:559-585-8764
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist