Provider Demographics
NPI:1467593814
Name:BRUCE G. FAY, DMD, PA
Entity Type:Organization
Organization Name:BRUCE G. FAY, DMD, PA
Other - Org Name:NEW CONCEPT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-778-3822
Mailing Address - Street 1:900 FOULK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3155
Mailing Address - Country:US
Mailing Address - Phone:302-778-3822
Mailing Address - Fax:302-778-3826
Practice Address - Street 1:900 FOULK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3155
Practice Address - Country:US
Practice Address - Phone:302-778-3822
Practice Address - Fax:302-778-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000979731Medicaid
DE=========Medicare UPIN