Provider Demographics
NPI:1841264561
Name:DENNETT, DANIEL DORAN (MS,ATC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DORAN
Last Name:DENNETT
Suffix:
Gender:M
Credentials:MS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MOORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1110
Mailing Address - Country:US
Mailing Address - Phone:518-798-8644
Mailing Address - Fax:
Practice Address - Street 1:2388 ROUTE 9
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-3024
Practice Address - Country:US
Practice Address - Phone:518-899-0022
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001141-1174400000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program