Provider Demographics
NPI:1083189609
Name:CHILDREN'S DENTAL HEALTH OF DELAWARE, LLC
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL HEALTH OF DELAWARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-500-2042
Mailing Address - Street 1:200 WILLOWBROOK LN STE 220
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5697
Mailing Address - Country:US
Mailing Address - Phone:610-500-2042
Mailing Address - Fax:610-884-6296
Practice Address - Street 1:3301 LANCASTER PIKE # 3E3F
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1436
Practice Address - Country:US
Practice Address - Phone:302-803-6560
Practice Address - Fax:302-803-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty