Healthcare Provider Details

I. General information

NPI: 1598060923
Provider Name (Legal Business Name): MICHAEL ROBERT DALEY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2011
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 S GULPH RD
KING OF PRUSSIA PA
19406-3136
US

IV. Provider business mailing address

1600 HORIZON DR SUITE 101
CHALFONT PA
18914-4100
US

V. Phone/Fax

Practice location:
  • Phone: 610-337-2325
  • Fax:
Mailing address:
  • Phone: 215-822-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS038349
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: