Provider Demographics
NPI:1477281749
Name:DARALDIK, AWS
Entity Type:Individual
Prefix:
First Name:AWS
Middle Name:
Last Name:DARALDIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 HADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3371
Mailing Address - Country:US
Mailing Address - Phone:973-932-4422
Mailing Address - Fax:
Practice Address - Street 1:1053 BLOOMFIELD AVE STE 14
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2120
Practice Address - Country:US
Practice Address - Phone:973-932-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02913100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty