Provider Demographics
NPI:1053501361
Name:DALEY, COLLEEN CAROL (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:CAROL
Last Name:DALEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:DALEY
Other - Last Name:FAIRHURST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5219 LANKFORD HWY
Mailing Address - Street 2:
Mailing Address - City:NEW CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:23415-3332
Mailing Address - Country:US
Mailing Address - Phone:757-824-5676
Mailing Address - Fax:
Practice Address - Street 1:5219 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:NEW CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23415-3332
Practice Address - Country:US
Practice Address - Phone:757-824-5676
Practice Address - Fax:757-787-3466
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist