Provider Demographics
NPI:1841976859
Name:MACIAS, DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MACIAS
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 1:32404 MARIA CT
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4275
Mailing Address - Country:US
Mailing Address - Phone:248-792-1569
Mailing Address - Fax:
Practice Address - Street 1:22211 W WARREN ST STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2597
Practice Address - Country:US
Practice Address - Phone:313-982-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist