Healthcare Provider Details

I. General information

NPI: 1922099043
Provider Name (Legal Business Name): DAVID Z DAI D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LONG LN 1ST FLOOR
UPPER DARBY PA
19082-3112
US

IV. Provider business mailing address

140 EDGEHILL RD
BALA CYNWYD PA
19004-3145
US

V. Phone/Fax

Practice location:
  • Phone: 610-352-2263
  • Fax: 610-352-2261
Mailing address:
  • Phone: 610-660-0574
  • Fax: 610-352-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS030950Y
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: