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Pediatric Dentistry

Newark, Delaware

Provider NPI: 1689751265

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 302-834-4000  Fax: --

Business Mailing Address:
Tel: 856-769-3077  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Pediatric Dentistry
N1223P0221XDental Providers
N1223P0221XDental Providers
NJDI 01930700

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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