Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 17698 | TX |
NPI | 1124141973 |
---|---|
Provider Name | Dr. William Wayner Daniels |
First Address | College Station, TX 77840 |
Second Address | College Station, TX 77840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |