Provider Demographics
NPI:1407913106
Name:DAY, DARRELL GLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:GLEN
Last Name:DAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 MATLOCK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1004
Mailing Address - Country:US
Mailing Address - Phone:817-472-0888
Mailing Address - Fax:817-472-9753
Practice Address - Street 1:4501 MATLOCK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1004
Practice Address - Country:US
Practice Address - Phone:817-472-0888
Practice Address - Fax:817-472-9753
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice