Healthcare Provider Details

I. General information

NPI: 1427567379
Provider Name (Legal Business Name): MID-ATLANTIC DENTAL PARTNERS DELAWARE II PROFESSIONAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 MILLER RD
WILMINGTON DE
19802-1914
US

IV. Provider business mailing address

600 W GERMANTOWN PIKE STE 400
PLYMOUTH MEETING PA
19462-1046
US

V. Phone/Fax

Practice location:
  • Phone: 302-765-2272
  • Fax: 302-765-0800
Mailing address:
  • Phone: 856-381-7196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE D BAALS
Title or Position: DIRECTOR OF OPERATIONS
Credential: RDH
Phone: 856-381-7196