Provider Demographics
NPI:1750404216
Name:DANIELS, TROY E (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:E
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MENDOSA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1943
Mailing Address - Country:US
Mailing Address - Phone:415-731-8722
Mailing Address - Fax:
Practice Address - Street 1:0422 UNIVERSITY OF CALIFORNIA
Practice Address - Street 2:512 PARNASSUS AVENUE, C-634
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-476-2431
Practice Address - Fax:415-476-4204
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA508571Medicaid
CA19600OtherDENTAL LICENSE
CAAD4500270OtherDEA REGISTRATION NUMBER
CAT07953Medicare UPIN