Provider Demographics
NPI:1336100023
Name:DELMARVA PROSTHODONTICS PA
Entity Type:Organization
Organization Name:DELMARVA PROSTHODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-674-8331
Mailing Address - Street 1:871 S GOVERNORS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4115
Mailing Address - Country:US
Mailing Address - Phone:302-674-8331
Mailing Address - Fax:302-674-4342
Practice Address - Street 1:871 S GOVERNORS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4115
Practice Address - Country:US
Practice Address - Phone:302-674-8331
Practice Address - Fax:302-674-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE10061223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001058231Medicaid
DE0001058231Medicaid