Healthcare Provider Details

I. General information

NPI: 1710739594
Provider Name (Legal Business Name): DELAWARE DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20785 PROFESSIONAL PARK BLVD
GEORGETOWN DE
19947-3198
US

IV. Provider business mailing address

101 MULBERRY LN
MEDIA PA
19063-1627
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-9499
  • Fax:
Mailing address:
  • Phone: 609-256-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NANCY PANCKO
Title or Position: MEMBER
Credential:
Phone: 609-256-1702