Provider Demographics
NPI:1881074565
Name:PHAN, DANIELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:PHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1729 ANALOG DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-1944
Mailing Address - Country:US
Mailing Address - Phone:972-437-0200
Mailing Address - Fax:
Practice Address - Street 1:1729 ANALOG DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1944
Practice Address - Country:US
Practice Address - Phone:972-437-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice