Provider Demographics
NPI:1679862676
Name:DALY DENTAL
Entity Type:Organization
Organization Name:DALY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-388-4432
Mailing Address - Street 1:152 MAPLE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-4423
Mailing Address - Fax:
Practice Address - Street 1:152 MAPLE STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-4423
Practice Address - Fax:802-388-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160050979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty