Healthcare Provider Details

I. General information

NPI: 1437120110
Provider Name (Legal Business Name): DAGSBORO FAMILY PRACTICE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29475 VINES CREEK RD
DAGSBORO DE
19939-3839
US

IV. Provider business mailing address

29475 VINES CREEK RD
DAGSBORO DE
19939-3839
US

V. Phone/Fax

Practice location:
  • Phone: 302-732-9593
  • Fax: 302-732-9598
Mailing address:
  • Phone: 302-732-9593
  • Fax: 302-732-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0002872
License Number StateDE

VIII. Authorized Official

Name: DR. PRENTISS WAYNE ADKINS SR.
Title or Position: PRESIDENT
Credential: D.O.
Phone: 302-732-9593