Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 05792 | MD |
NPI | 1023231636 |
---|---|
Provider Name | Thomas E. Daley |
First Address | Towson, MD 21286-1802 |
Second Address | Towson, MD 21286-1802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |