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General NPI Number Information
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NPI Number | 1861800591
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Entity Type | Organization
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Legal Business Name | DANIEL DAFO,DDS, INC.
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 1500 GRAND CENTRAL AVE SUITE 104
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City | VIENNA
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State | WV
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Zip | 26105-1079
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Country | US
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Telephone | 304-295-8256
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Fax | 304-295-8261
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Provider Business Mailing Address
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Address Line | 1500 GRAND CENTRAL AVE SUITE 104
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City | VIENNA
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State | WV
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Zip | 26105-1079
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Country | US
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Telephone | 304-295-8256
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Fax | 304-295-8261
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. DANIEL DAFO
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Credential | DDS
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Telephone | 304-295-8256
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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 | 4038
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License Number State | WV
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