Provider Demographics
NPI:1265327282
Name:GONCHARUK, DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:GONCHARUK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16255 ALLURA CIR UNIT 3317
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9325
Mailing Address - Country:US
Mailing Address - Phone:646-468-9413
Mailing Address - Fax:
Practice Address - Street 1:9530 BONITA BEACH RD SE STE 103
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4769
Practice Address - Country:US
Practice Address - Phone:239-948-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist