Healthcare Provider Details

I. General information

NPI: 1417875220
Provider Name (Legal Business Name): DAILEY OMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 OUTLOOK DR STE 105
WALL TOWNSHIP NJ
07753-6839
US

IV. Provider business mailing address

4814 OUTLOOK DR STE 105
WALL TOWNSHIP NJ
07753-6839
US

V. Phone/Fax

Practice location:
  • Phone: 732-673-9792
  • Fax:
Mailing address:
  • Phone: 732-673-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MARISA REBECCA DAILEY
Title or Position: OWNER
Credential: DDS
Phone: 732-673-9792