Provider Demographics
NPI:1831246024
Name:ARMISTEAD, DANIEL BADGLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BADGLEY
Last Name:ARMISTEAD
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 1:2233 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3905
Mailing Address - Country:US
Mailing Address - Phone:650-326-4466
Mailing Address - Fax:650-326-5075
Practice Address - Street 1:2233 ALMA ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3905
Practice Address - Country:US
Practice Address - Phone:650-326-4466
Practice Address - Fax:650-326-5075
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27225OtherDENTAL LICENSE #