Provider Demographics
NPI:1649283466
Name:LONGACRE, DANIEL JEFFREY (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JEFFREY
Last Name:LONGACRE
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 1:30131 TOWN CENTER DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2034
Mailing Address - Country:US
Mailing Address - Phone:949-495-2000
Mailing Address - Fax:949-495-1464
Practice Address - Street 1:30131 TOWN CENTER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2034
Practice Address - Country:US
Practice Address - Phone:949-495-2000
Practice Address - Fax:949-495-1464
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice