Provider Demographics
NPI:1487679908
Name:DALEY, DANIEL J JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:DALEY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:JOSEPH
Other - Last Name:DALEY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2300 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-1102
Mailing Address - Country:US
Mailing Address - Phone:610-623-4211
Mailing Address - Fax:610-623-2850
Practice Address - Street 1:2300 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1102
Practice Address - Country:US
Practice Address - Phone:610-623-4211
Practice Address - Fax:610-623-2850
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017186L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000526363 0001Medicaid
PA000526363 0001Medicaid
PA131451Medicare PIN