Basic Information
| Provider Information | |||||||||
| NPI: | 1083815989 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DANIEL L MORIN DDS MS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 S 4J RD | ||||||||
| Address2: | |||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827164132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076865665 | ||||||||
| FaxNumber: | 3076867473 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 S 4J RD | ||||||||
| Address2: | |||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827164132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076865665 | ||||||||
| FaxNumber: | 3076867473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 05/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | MORIN | ||||||||
| AuthorizedOfficialFirstName: | KEELY | ||||||||
| AuthorizedOfficialMiddleName: | DANA | ||||||||
| AuthorizedOfficialTitleorPosition: | CORPORATE SECRETARY-TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 3076865665 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 929 | WY | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.