Provider Demographics
NPI:1710739594
Name:DELAWARE DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:DELAWARE DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-256-1702
Mailing Address - Street 1:101 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1627
Mailing Address - Country:US
Mailing Address - Phone:609-256-1702
Mailing Address - Fax:
Practice Address - Street 1:20785 PROFESSIONAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-3198
Practice Address - Country:US
Practice Address - Phone:302-855-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental