Daryl Proctor, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

41776 Issued in CA

Practice address

4282 Golden Center Dr Ste 2
Suite 2
Placerville, CA 95667-6286

Phone

(530) 622-1525

Fax

(951) 697-6807

NPI assigned

Nov 30, 2006

Last updated

May 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1629145743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4282 GOLDEN CENTER DR STE 2",
            "address_2": "SUITE 2",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956676286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4282 GOLDEN CENTER DR STE 2",
            "address_2": "SUITE 2",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956676286",
            "telephone_number": "530-622-1525",
            "fax_number": "951-697-6807"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8400 Wood Thrush Way",
            "address_purpose": "LOCATION",
            "city": "Granite Bay",
            "state": "CA",
            "postal_code": "957466120",
            "country_code": "US",
            "telephone_number": "530-622-1525",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "655 New York Ranch Rd",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "CA",
            "postal_code": "956429386",
            "country_code": "US",
            "telephone_number": "209-223-0525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "DARYL",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "41776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Health of Placerville Inc (Premier Healthcare)
• Premier Healthcare of Placerville (Premier Healthcare)
• Kimberly Sue Price
• Susan Price, R.N.
• Dallas Privett
• Professional Services Associates a Professional Psychological Corporat
• Progress House
• Progress House Inc Detox Center
• Progress House, Inc.
• Progress House, Inc.

• Orthodontics and Dentofacial Orthopedics Dentistry in Placerville, CA
• Providers in Placerville, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.