Provider Demographics
NPI:1235261322
Name:FIRST STATE DENTAL P.A.
Entity Type:Organization
Organization Name:FIRST STATE DENTAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:D
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GIOFFRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-652-5312
Mailing Address - Street 1:1702 LOVERING AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2141
Mailing Address - Country:US
Mailing Address - Phone:302-652-5312
Mailing Address - Fax:302-652-8674
Practice Address - Street 1:1702 LOVERING AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2141
Practice Address - Country:US
Practice Address - Phone:302-652-5312
Practice Address - Fax:302-652-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1235261322Medicaid