Provider Demographics
NPI:1356365381
Name:DANIELS, ROBERT SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:DANIELS
Suffix:
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 1:201 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1759
Mailing Address - Country:US
Mailing Address - Phone:563-285-8662
Mailing Address - Fax:563-285-1337
Practice Address - Street 1:201 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1759
Practice Address - Country:US
Practice Address - Phone:563-285-8662
Practice Address - Fax:563-285-1337
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA72391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA27334OtherWELLMARK BC/BS
IA0056085Medicaid
IA469781OtherUNITED CONCORDIA