Healthcare Provider Details

I. General information

NPI: 1790986446
Provider Name (Legal Business Name): JAYNE ELIZABETH DELANEY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S PICKETT ST SUITE 120
ALEXANDRIA VA
22304-7207
US

IV. Provider business mailing address

50 S PICKETT ST SUITE 120
ALEXANDRIA VA
22304-7207
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-5437
  • Fax: 703-370-5473
Mailing address:
  • Phone: 703-370-5437
  • Fax: 703-370-5473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401008480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: