Active NPI
Lily Dalco
- Dentist
- Wayne, NJ
National Provider Identifier
1205524618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI03036700
- Practice address
- 202 Church LN
Wayne, NJ 07470-3323 - Phone
- (973) 874-3790
- NPI assigned
- Apr 25, 2023
- Last updated
- Jul 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI03036700 | NJ | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
202 Church LN
Wayne, NJ 07470-3323
Mailing address
202 Church LN
Wayne, NJ 07470-3323
Phone (973) 874-3790
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI03036700 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720656000000",
"number": "1205524618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 CHURCH LN",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074703323",
"telephone_number": "973-874-3790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 CHURCH LN",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074703323",
"telephone_number": "973-874-3790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALCO",
"first_name": "LILY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-04-25",
"last_updated": "2024-07-11",
"certification_date": "2024-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI03036700",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayne, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.