Individual
DR. DANIEL LEE MASSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
200 N GIANT CITY RD, CARBONDALE, IL 62902-6410
(618) 529-2711
(618) 351-0393
Mailing address
200 N GIANT CITY RD, CARBONDALE, IL 62902-6410
(618) 529-2711
(618) 351-0393
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19-025510
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37-1408733
T.I.N.
IL
Enumeration date
11/08/2006
Last updated
02/16/2016
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