Provider Demographics
NPI:1508145970
Name:FAY, DANIEL JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:FAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 S NEW ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3573
Mailing Address - Country:US
Mailing Address - Phone:302-734-8101
Mailing Address - Fax:302-734-1857
Practice Address - Street 1:748 S NEW ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3573
Practice Address - Country:US
Practice Address - Phone:302-734-8101
Practice Address - Fax:302-734-1857
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00013231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice