Provider Demographics
NPI:1073024634
Name:DANIELLE J DEY DDS, LLC
Entity Type:Organization
Organization Name:DANIELLE J DEY DDS, LLC
Other - Org Name:MODERN ELEVATIONS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-785-7444
Mailing Address - Street 1:10991B NATIONAL RD SW
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8107
Mailing Address - Country:US
Mailing Address - Phone:740-785-7444
Mailing Address - Fax:
Practice Address - Street 1:10991B NATIONAL RD SW
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:OH
Practice Address - Zip Code:43062-8107
Practice Address - Country:US
Practice Address - Phone:740-785-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-22
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024073261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental