Provider Demographics
NPI:1417424649
Name:LINDELL PLAZA DENTAL LLC
Entity Type:Organization
Organization Name:LINDELL PLAZA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EMMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-999-8113
Mailing Address - Street 1:1601 MILLTOWN RD STE 26B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4027
Mailing Address - Country:US
Mailing Address - Phone:302-999-8113
Mailing Address - Fax:
Practice Address - Street 1:1601 MILLTOWN RD STE 26B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4027
Practice Address - Country:US
Practice Address - Phone:302-999-8113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty