Provider Demographics
NPI:1578691838
Name:MAPLEWOOD DENTAL LLC
Entity Type:Organization
Organization Name:MAPLEWOOD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER OF THE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCKENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-645-6671
Mailing Address - Street 1:18913 JOHN J WILLIAMS HWY
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4404
Mailing Address - Country:US
Mailing Address - Phone:302-645-6671
Mailing Address - Fax:302-645-6671
Practice Address - Street 1:18913 JOHN J WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4404
Practice Address - Country:US
Practice Address - Phone:302-645-6671
Practice Address - Fax:302-645-6671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000893308Medicaid