Provider Demographics
NPI:1336521152
Name:DAVID S DALEY, DMD, PC
Entity type:Organization
Organization Name:DAVID S DALEY, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PC
Authorized Official - Phone:480-963-0338
Mailing Address - Street 1:1600 W CHANDLER BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6162
Mailing Address - Country:US
Mailing Address - Phone:480-963-0338
Mailing Address - Fax:480-963-6468
Practice Address - Street 1:1600 W CHANDLER BLVD STE 210
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6162
Practice Address - Country:US
Practice Address - Phone:480-963-0338
Practice Address - Fax:480-963-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicaid