Provider Demographics
NPI:1063434595
Name:DRISCOLL, DANIEL FRANCIS (DDS, PLLC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:FRANCIS
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:DDS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 RIVER CHASE RDG
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4470
Mailing Address - Country:US
Mailing Address - Phone:336-794-9148
Mailing Address - Fax:
Practice Address - Street 1:3314 HEALY DR STE 101
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1408
Practice Address - Country:US
Practice Address - Phone:336-765-4911
Practice Address - Fax:336-765-4913
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6976OtherNC LICENSE NUMBER
NC89902YMMedicaid
NCBD6696871OtherDEA NUMBER