Provider Demographics
NPI:1427287481
Name:MUCKENTHALER, DANIELLE THEA (DDS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:THEA
Last Name:MUCKENTHALER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:THEA
Other - Last Name:SATRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:285 BRAMBLY VINE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8410
Mailing Address - Country:US
Mailing Address - Phone:218-841-3740
Mailing Address - Fax:
Practice Address - Street 1:268 HERBERT ST
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4000
Practice Address - Country:US
Practice Address - Phone:904-829-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010199921223G0001X
FL26226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice