Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 45074 | CA |
NPI | 1124109632 |
---|---|
Provider Name | Dr. Gerald Layne Danielson |
First Address | Fresno, CA 93710-8600 |
Second Address | Fresno, CA 93710-8600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 15/05/2019 |