Provider Demographics
NPI:1124837059
Name:AGUILERA, DANIEL ENRIQUE
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ENRIQUE
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SCHROEDER CT STE 300
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2528
Mailing Address - Country:US
Mailing Address - Phone:608-231-2006
Mailing Address - Fax:
Practice Address - Street 1:34 SCHROEDER CT STE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2528
Practice Address - Country:US
Practice Address - Phone:608-231-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001719-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice