Provider Demographics
NPI:1912219940
Name:EASTMAN, DANIEL DOUGLAS (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:DOUGLAS
Last Name:EASTMAN
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 1:1617 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1831
Mailing Address - Country:US
Mailing Address - Phone:757-357-7500
Mailing Address - Fax:
Practice Address - Street 1:1617 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1831
Practice Address - Country:US
Practice Address - Phone:757-357-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA040141942431223G0001X
TX00255931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice