Provider Demographics
NPI:1497854194
Name:WILMINGTON DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:WILMINGTON DENTAL ASSOCIATES
Other - Org Name:ROBERT R HOOPES DDS JOHN J LENZ DDS CHARTERED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-654-6915
Mailing Address - Street 1:2309 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806
Mailing Address - Country:US
Mailing Address - Phone:302-654-6915
Mailing Address - Fax:302-654-3218
Practice Address - Street 1:2309 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806
Practice Address - Country:US
Practice Address - Phone:302-654-6915
Practice Address - Fax:302-654-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
DE19890139611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty