Provider Demographics
NPI:1801535067
Name:BRIAN L DANIELSSON DDS PC
Entity type:Organization
Organization Name:BRIAN L DANIELSSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DANIELSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-371-4800
Mailing Address - Street 1:700A N SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3528
Mailing Address - Country:US
Mailing Address - Phone:760-371-4800
Mailing Address - Fax:760-371-4825
Practice Address - Street 1:700A N SANDERS ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3528
Practice Address - Country:US
Practice Address - Phone:760-371-4800
Practice Address - Fax:760-371-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty