Provider Demographics
NPI:1457840266
Name:MCDANIEL, BRITTANY RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:RENEE
Last Name:MCDANIEL
Suffix:
Gender:F
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:P.O. BOX 2980
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-7086
Mailing Address - Country:US
Mailing Address - Phone:505-224-8718
Mailing Address - Fax:505-224-8737
Practice Address - Street 1:7 MUNICIPAL WAY
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-7086
Practice Address - Country:US
Practice Address - Phone:505-224-8718
Practice Address - Fax:505-224-8737
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMTD-00-109390200000X
NMDD5072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program