Basic Information
| Provider Information | |||||||||
| NPI: | 1821211319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOPER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1137 INDEPENDENCE DR | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657754221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172558464 | ||||||||
| FaxNumber: | 4172559741 | ||||||||
| Practice Location | |||||||||
| Address1: | 1137 INDEPENDENCE DR | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657754221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172558464 | ||||||||
| FaxNumber: | 4172559741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 02/20/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 25631 | CA | N | Dental Providers | Dentist | 122300000X | 2009026479 | MO | Y | Dental Providers | Dentist |
No ID Information.