Provider Demographics
NPI:1770704546
Name:DELMARVA ENDODONTICS, LLC
Entity type:Organization
Organization Name:DELMARVA ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HARTT
Authorized Official - Last Name:COATES
Authorized Official - Suffix:III
Authorized Official - Credentials:BA
Authorized Official - Phone:410-629-1240
Mailing Address - Street 1:314 FRANKLIN AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1215
Mailing Address - Country:US
Mailing Address - Phone:410-629-1240
Mailing Address - Fax:410-629-1340
Practice Address - Street 1:314 FRANKLIN AVE
Practice Address - Street 2:STE 303
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1215
Practice Address - Country:US
Practice Address - Phone:410-629-1240
Practice Address - Fax:410-629-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD114071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty