1770704546 NPI number — DELMARVA ENDODONTICS, LLC

Table of content: (NPI 1770704546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770704546 NPI number — DELMARVA ENDODONTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELMARVA ENDODONTICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770704546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
314 FRANKLIN AVE
Provider Second Line Business Mailing Address:
STE 303
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21811-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-629-1240
Provider Business Mailing Address Fax Number:
410-629-1340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
314 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-629-1240
Provider Business Practice Location Address Fax Number:
410-629-1340
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COATES
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
HARTT
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
410-629-1240

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  MD11407 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com