Provider Demographics
NPI:1295307338
Name:DANIALI, DALIA (DMD)
Entity type:Individual
Prefix:
First Name:DALIA
Middle Name:
Last Name:DANIALI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 WETHEROLE ST APT 1H
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4724
Mailing Address - Country:US
Mailing Address - Phone:347-662-4944
Mailing Address - Fax:
Practice Address - Street 1:6560 WETHEROLE ST APT 1H
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4724
Practice Address - Country:US
Practice Address - Phone:347-662-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02848500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist