Provider Demographics
NPI:1558921916
Name:URRUTIA, DANIELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:URRUTIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:POPIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4510 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8624
Mailing Address - Country:US
Mailing Address - Phone:954-552-0263
Mailing Address - Fax:
Practice Address - Street 1:2250 SATELLITE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4919
Practice Address - Country:US
Practice Address - Phone:954-552-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1229461223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics