=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790986446
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYNE ELIZABETH DELANEY D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 S PICKETT ST SUITE 120
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-7207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-370-5437
-----------------------------------------------------
Fax | 703-370-5473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 S PICKETT ST SUITE 120
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-7207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-370-5437
-----------------------------------------------------
Fax | 703-370-5473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 0401008480
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------