Provider Demographics
NPI:1982765038
Name:FIDANCE, ERNEST M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:M
Last Name:FIDANCE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 KENNETT PIKE
Mailing Address - Street 2:C100
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2321
Mailing Address - Country:US
Mailing Address - Phone:302-656-8219
Mailing Address - Fax:302-656-6623
Practice Address - Street 1:3801 KENNETT PIKE
Practice Address - Street 2:C100
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2321
Practice Address - Country:US
Practice Address - Phone:302-656-8219
Practice Address - Fax:302-656-6623
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10000610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001045408Medicaid