Healthcare Provider Details

I. General information

NPI: 1699235937
Provider Name (Legal Business Name): BRANDYWINE PEDIATRIC DENTISTRY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOULK RD STE C
WILMINGTON DE
19810-3642
US

IV. Provider business mailing address

2000 FOULK RD STE C
WILMINGTON DE
19810-3642
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-3110
  • Fax: 302-475-5206
Mailing address:
  • Phone: 302-475-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JILL L GARRIDO
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 302-475-3110