Provider Demographics
NPI:1851441133
Name:WEATHERHILL DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:WEATHERHILL DENTAL ASSOCIATES PA
Other - Org Name:WEATHERHILL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:THOMAS-GLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-239-6677
Mailing Address - Street 1:5317 LIMESTONE ROAD, SU 2
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-239-6677
Mailing Address - Fax:302-239-8222
Practice Address - Street 1:5317 LIMESTONE ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-239-6677
Practice Address - Fax:302-239-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG00011451223G0001X
DE19890216831223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021659Medicaid