Provider Demographics
NPI:1437688421
Name:MID ATLANTIC DENTAL PARTNERS DELAWARE 1, PA
Entity Type:Organization
Organization Name:MID ATLANTIC DENTAL PARTNERS DELAWARE 1, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOFFRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
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 1:330 CHRISTIANA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1653
Practice Address - Country:US
Practice Address - Phone:302-369-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty