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General NPI Number Information
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NPI Number | 1679862676
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Entity Type | Organization
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Legal Business Name | DALY DENTAL
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 152 MAPLE STREET SUITE 201
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City | MIDDLEBURY
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State | VT
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Zip | 05753
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Country | US
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Telephone | 802-388-4423
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Fax | 802-388-7457
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Provider Business Mailing Address
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Address Line | 152 MAPLE STREET SUITE 201
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City | MIDDLEBURY
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State | VT
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Zip | 05753
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Country | US
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Telephone | 802-388-4423
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ANDREW JOHN DALY
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Credential | DMD
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Telephone | 802-388-4432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0160050979
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License Number State | VT
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