Provider Demographics
NPI:1245215193
Name:DALY, JANE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:DALY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:MARIE
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:18109 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 245
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1519
Mailing Address - Country:US
Mailing Address - Phone:301-924-2155
Mailing Address - Fax:301-924-2376
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 245
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-924-2155
Practice Address - Fax:301-924-2376
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD96331223S0112X
DCCS88037241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC000D61M93Medicare ID - Type Unspecified
T30835Medicare UPIN