Individual
DALLAS MARK DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDH
Contact information
Practice address
2930 11TH AVE, EVANS, CO 80620-1011
(970) 353-9403
(970) 353-9906
Mailing address
1006 A ST, GREELEY, CO 80631-2021
(970) 352-0048
(970) 353-9403
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
905511
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
905511
STATE LICENSE
CO
Enumeration date
12/17/2012
Last updated
12/17/2012
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