Healthcare Provider Details

I. General information

NPI: 1174362560
Provider Name (Legal Business Name): DR. DANIIL AFANASYEVICH DOLYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 DEFENSE HWY STE 210
CROFTON MD
21114-2942
US

IV. Provider business mailing address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

V. Phone/Fax

Practice location:
  • Phone: 443-233-5117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18456
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: