Healthcare Provider Details

I. General information

NPI: 1558452177
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGERY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 ANNAND DR STE 10
WILMINGTON DE
19808-3719
US

IV. Provider business mailing address

2601 ANNAND DR STE 10
WILMINGTON DE
19808-3719
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0331
  • Fax: 302-998-5410
Mailing address:
  • Phone: 302-998-0331
  • Fax: 302-998-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberGI-0001107
License Number StateDE

VIII. Authorized Official

Name: DR. DAVID KING
Title or Position: OWNER
Credential: DMD
Phone: 302-998-0331