Provider Demographics
NPI:1841765955
Name:BLUE HEN DENTAL LLC
Entity Type:Organization
Organization Name:BLUE HEN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BAQI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-314-3077
Mailing Address - Street 1:231 S DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1550
Mailing Address - Country:US
Mailing Address - Phone:302-314-3077
Mailing Address - Fax:
Practice Address - Street 1:231 S DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1550
Practice Address - Country:US
Practice Address - Phone:302-314-3077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental