Provider Demographics
NPI:1063522787
Name:RAIFORD, DANIEL MORGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MORGAN
Last Name:RAIFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N TRYON ST
Mailing Address - Street 2:UNIT 615
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1170
Mailing Address - Country:US
Mailing Address - Phone:704-375-2252
Mailing Address - Fax:704-338-1640
Practice Address - Street 1:706 WEST KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086
Practice Address - Country:US
Practice Address - Phone:704-739-3601
Practice Address - Fax:704-739-0800
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37131223G0001X
GADN0079191223G0001X
FLPN69641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7997231Medicaid
NC7997231Medicaid