Healthcare Provider Details

I. General information

NPI: 1285331603
Provider Name (Legal Business Name): WILMINGTON PEDIATRIC DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILMINGTON PEDIATRIC DENTISTRY 3105 LIMESTONE RD SUITE 305
WILMINGTON DE
19808
US

IV. Provider business mailing address

WILMINGTON PEDIATRIC DENTISTRY 3105 LIMESTONE RD SUITE 305
WILMINGTON DE
19808
US

V. Phone/Fax

Practice location:
  • Phone: 302-933-9900
  • Fax:
Mailing address:
  • Phone: 302-933-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LIDA ALIMORAD
Title or Position: PROVIDER/OWNER
Credential: DDS
Phone: 301-641-7143