Provider Demographics
NPI:1932645041
Name:SALLY B DALY DDS LLC
Entity Type:Organization
Organization Name:SALLY B DALY DDS LLC
Other - Org Name:FLEUR DE LIS MOBILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-810-5619
Mailing Address - Street 1:PO BOX 40992
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835-0992
Mailing Address - Country:US
Mailing Address - Phone:225-767-5343
Mailing Address - Fax:225-767-4009
Practice Address - Street 1:11822 JUSTICE AVENUE #84
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-767-5343
Practice Address - Fax:225-767-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3767-14122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty