Healthcare Provider Details

I. General information

NPI: 1497854194
Provider Name (Legal Business Name): WILMINGTON DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 PENNSYLVANIA AVE
WILMINGTON DE
19806
US

IV. Provider business mailing address

2309 PENNSYLVANIA AVE
WILMINGTON DE
19806
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-6915
  • Fax: 302-654-3218
Mailing address:
  • Phone: 302-654-6915
  • Fax: 302-654-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1989013961
License Number StateDE

VIII. Authorized Official

Name: DR. JOHN J LENZ
Title or Position: DENTIST
Credential: DDS
Phone: 302-654-6915