Provider Demographics
NPI:1154369569
Name:DRS MENNITT & DALY, PA
Entity type:Organization
Organization Name:DRS MENNITT & DALY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENNITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-924-2155
Mailing Address - Street 1:18109 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE 245
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1519
Mailing Address - Country:US
Mailing Address - Phone:301-924-2155
Mailing Address - Fax:301-924-2376
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 245
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-924-2155
Practice Address - Fax:301-924-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD96331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00093Medicare PIN