Provider Demographics
NPI:1316505290
Name:MCDANIEL, CLAUDIA RANDOW (DDS)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:RANDOW
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 N CONGRESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8268
Mailing Address - Country:US
Mailing Address - Phone:561-572-3555
Mailing Address - Fax:
Practice Address - Street 1:1790 N CONGRESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8268
Practice Address - Country:US
Practice Address - Phone:561-572-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416521122300000X
FLDN265921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist