Provider Demographics
NPI:1467011783
Name:DANIEL, CHRISTOPHER KYLE (DMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:KYLE
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-1251
Mailing Address - Country:US
Mailing Address - Phone:706-857-4741
Mailing Address - Fax:
Practice Address - Street 1:19 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1251
Practice Address - Country:US
Practice Address - Phone:706-857-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158431223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice