Healthcare Provider Details

I. General information

NPI: 1639090038
Provider Name (Legal Business Name): CCD DELAWARE 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18947 JOHN J WILLIAMS HWY UNIT 301
REHOBOTH BEACH DE
19971-4477
US

IV. Provider business mailing address

18947 JOHN J WILLIAMS HWY UNIT 301
REHOBOTH BEACH DE
19971-4477
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-7200
  • Fax:
Mailing address:
  • Phone: 302-645-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KEITH DUNOFF
Title or Position: DENTAL DIRECTOR
Credential: DMD
Phone: 609-790-4886