Provider Demographics
NPI:1932693777
Name:DELAWARE DENTAL STUDIO LLC
Entity Type:Organization
Organization Name:DELAWARE DENTAL STUDIO LLC
Other - Org Name:DELAWARE DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:ZELIGS
Authorized Official - Last Name:FEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-656-0391
Mailing Address - Street 1:2102 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2236
Mailing Address - Country:US
Mailing Address - Phone:408-656-0391
Mailing Address - Fax:
Practice Address - Street 1:2500 GRUBB RD STE 130
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4711
Practice Address - Country:US
Practice Address - Phone:408-656-0391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001387261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental