Healthcare Provider Details

I. General information

NPI: 1316256712
Provider Name (Legal Business Name): ANTHONY MURRAY DAILLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2010
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST STE 302
BERKELEY CA
94705-2118
US

IV. Provider business mailing address

2999 REGENT ST STE 3023
BERKELEY CA
94705-2190
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-0114
  • Fax:
Mailing address:
  • Phone: 510-848-0114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number29807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: