Provider Demographics
NPI:1295354165
Name:MID-ATLANTIC DENTAL PARTNERS DELAWARE PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:MID-ATLANTIC DENTAL PARTNERS DELAWARE PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-243-6602
Mailing Address - Street 1:630 W GERMANTOWN PIKE STE 120
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1074
Mailing Address - Country:US
Mailing Address - Phone:720-441-3423
Mailing Address - Fax:
Practice Address - Street 1:2101 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4710
Practice Address - Country:US
Practice Address - Phone:302-475-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty