Provider Demographics
NPI:1568207470
Name:MILLER SKINNER AND DASTRUP DENTAL CORPORATION OF ATWATER
Entity type:Organization
Organization Name:MILLER SKINNER AND DASTRUP DENTAL CORPORATION OF ATWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DASTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-274-5325
Mailing Address - Street 1:1095 N WINTON WAY
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301
Mailing Address - Country:US
Mailing Address - Phone:209-358-5485
Mailing Address - Fax:209-358-8446
Practice Address - Street 1:1095 N WINTON WAY
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301
Practice Address - Country:US
Practice Address - Phone:209-358-5485
Practice Address - Fax:209-358-8446
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLER SKINNER AND DASTRUP DENTAL CORPORATION OF ATWATER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty