Provider Demographics
NPI:1457895849
Name:PIKE CREEK DENTAL, LLC
Entity Type:Organization
Organization Name:PIKE CREEK DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-239-0410
Mailing Address - Street 1:4901 LIMESTONE RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1271
Mailing Address - Country:US
Mailing Address - Phone:302-239-0410
Mailing Address - Fax:
Practice Address - Street 1:4901 LIMESTONE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1271
Practice Address - Country:US
Practice Address - Phone:302-239-0410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001317332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1396181970Medicaid