Provider Demographics
NPI:1275044612
Name:DELAWARE PERIODONTICS AND IMPLANTS LLC
Entity Type:Organization
Organization Name:DELAWARE PERIODONTICS AND IMPLANTS LLC
Other - Org Name:WILMINGTON PERIODONTICS AND IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SANZ MOLINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-307-7789
Mailing Address - Street 1:2300 PENNSYLVANIA AVE UNIT 5D
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1392
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 PENNSYLVANIA AVE UNIT 5D
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1392
Practice Address - Country:US
Practice Address - Phone:302-652-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100013701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1275932006OtherNPI