Provider Demographics
NPI:1093865289
Name:THE DELAWARE CENTER FOR ENDODONTICS AND MICROSURGERY
Entity Type:Organization
Organization Name:THE DELAWARE CENTER FOR ENDODONTICS AND MICROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGEOR
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEARING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-285-0350
Mailing Address - Street 1:114 SAINT ANNES CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1495
Mailing Address - Country:US
Mailing Address - Phone:302-285-0350
Mailing Address - Fax:
Practice Address - Street 1:114 SAINT ANNES CHURCH RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1495
Practice Address - Country:US
Practice Address - Phone:302-285-0350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000037174Medicaid
DE671436OtherUNITED CONCORDIA PROVIDER
DE1000037158Medicaid