Provider Demographics
NPI:1851408579
Name:DEAKYNE, DENTAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DEAKYNE, DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEAKYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-653-6661
Mailing Address - Street 1:27 DEAK DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1268
Mailing Address - Country:US
Mailing Address - Phone:302-653-6661
Mailing Address - Fax:302-653-0661
Practice Address - Street 1:27 DEAK DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1268
Practice Address - Country:US
Practice Address - Phone:302-653-6661
Practice Address - Fax:302-653-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE7851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000014377Medicaid