Provider Demographics
NPI:1548473671
Name:DANIEL, PAMELA B (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:B
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7926 WRENWOOD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1786
Mailing Address - Country:US
Mailing Address - Phone:225-216-2252
Mailing Address - Fax:225-216-2254
Practice Address - Street 1:7926 WRENWOOD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1786
Practice Address - Country:US
Practice Address - Phone:225-216-2252
Practice Address - Fax:225-216-2254
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC7130OtherBLUE CROSSBLUE SHIELD
LA1843857Medicaid