Provider Demographics
NPI:1396765459
Name:SCANLAN, DANIEL J (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:SCANLAN
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 1:5777 W MAPLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2267
Mailing Address - Country:US
Mailing Address - Phone:248-626-3528
Mailing Address - Fax:248-737-7817
Practice Address - Street 1:5777 W MAPLE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2267
Practice Address - Country:US
Practice Address - Phone:248-626-3528
Practice Address - Fax:248-737-7817
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI84241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice