Provider Demographics
NPI:1477896785
Name:DAFO, DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DAFO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4391 RIDGEWOOD CENTER DR UNIT 1C
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5399
Mailing Address - Country:US
Mailing Address - Phone:304-210-6044
Mailing Address - Fax:703-382-6548
Practice Address - Street 1:4391 RIDGEWOOD CENTER DR UNIT 1C
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5399
Practice Address - Country:US
Practice Address - Phone:304-210-6044
Practice Address - Fax:703-382-6548
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist