Provider Demographics
NPI:1962518183
Name:SAMUEL DANIELS DDS MS PLLC
Entity type:Organization
Organization Name:SAMUEL DANIELS DDS MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS PLLC
Authorized Official - Phone:810-229-2776
Mailing Address - Street 1:305 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1525
Mailing Address - Country:US
Mailing Address - Phone:810-229-2776
Mailing Address - Fax:810-229-8080
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1525
Practice Address - Country:US
Practice Address - Phone:810-229-2776
Practice Address - Fax:810-229-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0142931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty