Individual
MICHAEL D MCDANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
203 MCCOMB ST, WILMOT, AR 71676
(870) 473-2311
(870) 473-5392
Mailing address
PO BOX 509, DERMOTT, AR 71638-0509
(870) 538-5414
(870) 538-5412
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1748
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100948608
—
AR
01
—
1748
STATE LICENSE
AR
01
—
58432
BLUE CROSS BLUE SHIELD
AR
Enumeration date
08/15/2006
Last updated
11/16/2011
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