Provider Demographics
NPI:1265620504
Name:DANIEL, RENIE (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:RENIE
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 DELAWARE ST SE
Mailing Address - Street 2:MOOS TOWER 7-174D
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-301-2233
Mailing Address - Fax:612-624-2669
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:MOOS TOWER 7-174D
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4220
Practice Address - Country:US
Practice Address - Phone:612-301-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-006261223S0112X
NJ22DI02345200204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery