Provider Demographics
NPI:1952661902
Name:PETER F. SUBACH DMD,PA
Entity Type:Organization
Organization Name:PETER F. SUBACH DMD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:SUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-995-1870
Mailing Address - Street 1:1601 MILLTOWN RD
Mailing Address - Street 2:SUITE#17
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4027
Mailing Address - Country:US
Mailing Address - Phone:302-995-1870
Mailing Address - Fax:302-995-9568
Practice Address - Street 1:1601 MILLTOWN RD
Practice Address - Street 2:SUITE#17
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4027
Practice Address - Country:US
Practice Address - Phone:302-995-1870
Practice Address - Fax:302-995-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100010871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OOA187L88OtherPTAN
OOA187L88OtherPTAN