Provider Demographics
NPI:1013370121
Name:BETHANY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:BETHANY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-537-1200
Mailing Address - Street 1:32895 COASTAL HWY UNIT 102
Mailing Address - Street 2:
Mailing Address - City:BETHANY BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19930-3783
Mailing Address - Country:US
Mailing Address - Phone:302-537-1200
Mailing Address - Fax:
Practice Address - Street 1:32895 COASTAL HWY UNIT 102
Practice Address - Street 2:
Practice Address - City:BETHANY BEACH
Practice Address - State:DE
Practice Address - Zip Code:19930-3783
Practice Address - Country:US
Practice Address - Phone:302-537-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1011261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental