1851441133 NPI number — WEATHERHILL DENTAL ASSOCIATES PA

Table of content: (NPI 1851441133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851441133 NPI number — WEATHERHILL DENTAL ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEATHERHILL DENTAL ASSOCIATES PA
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:
6
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:
1851441133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5317 LIMESTONE ROAD, SU 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-239-6677
Provider Business Mailing Address Fax Number:
302-239-8222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5317 LIMESTONE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-239-6677
Provider Business Practice Location Address Fax Number:
302-239-8222
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS-GLAVIN
Authorized Official First Name:
HOPE
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-239-6677

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  G0001145 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 1989021683 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000021659 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com