Provider Demographics
NPI:1750995205
Name:IGLESIAS, DANIYEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIYEL
Middle Name:
Last Name:IGLESIAS
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 1:17320 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2310
Mailing Address - Country:US
Mailing Address - Phone:305-807-4557
Mailing Address - Fax:
Practice Address - Street 1:4849 SW 148TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-2129
Practice Address - Country:US
Practice Address - Phone:954-880-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN254021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice