Provider Demographics
NPI:1831863737
Name:CDH DELAWARE ORTHODONTICS, LLC
Entity type:Organization
Organization Name:CDH DELAWARE ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHI
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-575-2321
Mailing Address - Street 1:300 WILLOWBROOK LN STE 330
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5594
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1436
Practice Address - Country:US
Practice Address - Phone:302-803-6560
Practice Address - Fax:302-803-6561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S DENTAL HEALTH OF DELAWARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty