Provider Demographics
NPI:1518205137
Name:DELAWARE ORAL & MAXILLOFACIAL SURGERY,LLC
Entity Type:Organization
Organization Name:DELAWARE ORAL & MAXILLOFACIAL SURGERY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWOGU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-595-4642
Mailing Address - Street 1:200 BIDDLE AVE
Mailing Address - Street 2:214
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3968
Mailing Address - Country:US
Mailing Address - Phone:302-595-4642
Mailing Address - Fax:302-595-4648
Practice Address - Street 1:200 BIDDLE AVE
Practice Address - Street 2:214
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3968
Practice Address - Country:US
Practice Address - Phone:302-595-4642
Practice Address - Fax:302-595-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty