Provider Demographics
NPI:1215098173
Name:MCLEOD, DANIEL CALHOUN (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CALHOUN
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1319
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-1319
Mailing Address - Country:US
Mailing Address - Phone:662-746-6433
Mailing Address - Fax:662-746-6471
Practice Address - Street 1:15415 HWY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194
Practice Address - Country:US
Practice Address - Phone:662-746-6433
Practice Address - Fax:662-746-6471
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS2050831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
621210OtherNAICS
8021OtherSIC