Provider Demographics
NPI:1255778783
Name:ARTHUR A. DANIELS DDS PC
Entity type:Organization
Organization Name:ARTHUR A. DANIELS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/TREASURET
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:A,
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-474-0082
Mailing Address - Street 1:174 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2961
Mailing Address - Country:US
Mailing Address - Phone:978-474-0082
Mailing Address - Fax:978-474-4104
Practice Address - Street 1:174 LOWELL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2961
Practice Address - Country:US
Practice Address - Phone:978-474-0082
Practice Address - Fax:978-474-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN115561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========Medicaid