MEDICARE: DR. JACK DAILEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D15432	MN

General Provider Information

NPI Number	:	1144150384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK DAILEY DDS

Provider Business Mailing Address
First Line	:	6399 BARRIE RD
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-2201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4103 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2259
Country	:	US
Telephone Number	:	612-721-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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