Provider Demographics
NPI:1811907405
Name:DANIELSON, STEPHEN HAROLD (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HAROLD
Last Name:DANIELSON
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:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:LAMBERTON
Mailing Address - State:MN
Mailing Address - Zip Code:56152-0427
Mailing Address - Country:US
Mailing Address - Phone:507-752-7327
Mailing Address - Fax:507-752-7328
Practice Address - Street 1:209 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMBERTON
Practice Address - State:MN
Practice Address - Zip Code:56152-1376
Practice Address - Country:US
Practice Address - Phone:507-752-7327
Practice Address - Fax:507-752-7328
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND75321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice