Provider Demographics
NPI:1508660432
Name:MCDANIELS, MATTHEW BRIAN (DMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRIAN
Last Name:MCDANIELS
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 1:200 ROSS RD APT H230
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2198
Mailing Address - Country:US
Mailing Address - Phone:734-741-3360
Mailing Address - Fax:
Practice Address - Street 1:1065 W. PERIMETER ROAD
Practice Address - Street 2:JB ANDREWS
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746
Practice Address - Country:US
Practice Address - Phone:734-741-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14224387-9926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist