Provider Demographics
NPI:1881991370
Name:FIFE, DANIEL SMART (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SMART
Last Name:FIFE
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 1:26932 OSO PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5815
Mailing Address - Country:US
Mailing Address - Phone:949-273-5505
Mailing Address - Fax:949-273-5508
Practice Address - Street 1:26932 OSO PKWY STE 240
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5815
Practice Address - Country:US
Practice Address - Phone:949-273-5505
Practice Address - Fax:949-273-5508
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist