Provider Demographics
NPI:1245384460
Name:DENTAL HEALTH ASSOCIATES OF PIKE CREEK VALLEY, P.A.
Entity Type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF PIKE CREEK VALLEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-239-0303
Mailing Address - Street 1:4901 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1271
Mailing Address - Country:US
Mailing Address - Phone:302-239-0303
Mailing Address - Fax:302-239-6755
Practice Address - Street 1:4901 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1271
Practice Address - Country:US
Practice Address - Phone:302-239-0303
Practice Address - Fax:302-239-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE19890200021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000917331Medicaid