Provider Demographics
NPI:1346778982
Name:THE DENTAL GROUP
Entity Type:Organization
Organization Name:THE DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMNISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-645-8993
Mailing Address - Street 1:34359 CARPENTERS WAY
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4910
Mailing Address - Country:US
Mailing Address - Phone:302-645-8993
Mailing Address - Fax:302-645-4506
Practice Address - Street 1:34359 CARPENTERS WAY
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4910
Practice Address - Country:US
Practice Address - Phone:302-645-8993
Practice Address - Fax:302-645-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200063082Medicaid