Provider Demographics
NPI:1326728825
Name:THE CHRISTIANA CENTER FOR ORAL & MAXILLOFACIAL SURGERY, P.A.
Entity Type:Organization
Organization Name:THE CHRISTIANA CENTER FOR ORAL & MAXILLOFACIAL SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-328-6777
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-0049
Mailing Address - Country:US
Mailing Address - Phone:302-328-6777
Mailing Address - Fax:302-292-8626
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:302-376-3700
Practice Address - Fax:302-319-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty