Provider Demographics
NPI:1427567379
Name:MID-ATLANTIC DENTAL PARTNERS DELAWARE II PROFESSIONAL ASSOCIATES
Entity Type:Organization
Organization Name:MID-ATLANTIC DENTAL PARTNERS DELAWARE II PROFESSIONAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAALS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:856-381-7196
Mailing Address - Street 1:600 W GERMANTOWN PIKE STE 400
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1046
Mailing Address - Country:US
Mailing Address - Phone:856-381-7196
Mailing Address - Fax:
Practice Address - Street 1:4201 MILLER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-1914
Practice Address - Country:US
Practice Address - Phone:302-765-2272
Practice Address - Fax:302-765-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty