Provider Demographics
NPI:1932239845
Name:DUROSEAU, DANIEL (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DUROSEAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:DUROSEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDA
Mailing Address - Street 1:270 E 7TH ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6602
Mailing Address - Country:US
Mailing Address - Phone:909-608-2390
Mailing Address - Fax:909-608-2307
Practice Address - Street 1:270 E 7TH ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6602
Practice Address - Country:US
Practice Address - Phone:909-608-2390
Practice Address - Fax:909-608-2307
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice