Provider Demographics
NPI:1205296761
Name:OCCEUS, DANENE ALISA (DDS)
Entity type:Individual
Prefix:
First Name:DANENE
Middle Name:ALISA
Last Name:OCCEUS
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 ENTERPRISE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8016
Mailing Address - Country:US
Mailing Address - Phone:386-456-9101
Mailing Address - Fax:386-218-5929
Practice Address - Street 1:2565 ENTERPRISE RD STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8016
Practice Address - Country:US
Practice Address - Phone:386-456-9101
Practice Address - Fax:386-218-5929
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22822122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist