Provider Demographics
NPI:1437415650
Name:DRS. ROBERT W. KIDD AND CHARIS O'CONNOR, PA
Entity Type:Organization
Organization Name:DRS. ROBERT W. KIDD AND CHARIS O'CONNOR, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-678-1440
Mailing Address - Street 1:850 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4113
Mailing Address - Country:US
Mailing Address - Phone:302-678-1440
Mailing Address - Fax:302-678-9984
Practice Address - Street 1:850 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4113
Practice Address - Country:US
Practice Address - Phone:302-678-1440
Practice Address - Fax:302-678-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001305261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental