Provider Demographics
NPI:1952696007
Name:ELEY, DANIEL WARREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WARREN
Last Name:ELEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3120
Mailing Address - Country:US
Mailing Address - Phone:321-622-8711
Mailing Address - Fax:
Practice Address - Street 1:2301 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3120
Practice Address - Country:US
Practice Address - Phone:321-622-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 193691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice