Provider Demographics
NPI:1780996389
Name:GANO, DANIEL R (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:GANO
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 1:27023 N 55TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20100 N 51ST AVE
Practice Address - Street 2:SUITE C-310
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5125
Practice Address - Country:US
Practice Address - Phone:623-572-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD92771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics