Healthcare Provider Details

I. General information

NPI: 1912940602
Provider Name (Legal Business Name): PETER FRANCIS SUBACH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MILLTOWN RD SUITE 17
WILMINGTON DE
19808
US

IV. Provider business mailing address

105 HOBSON DR WEST RIDING
HOCKESSIN DE
19707
US

V. Phone/Fax

Practice location:
  • Phone: 302-995-1870
  • Fax: 302-995-9568
Mailing address:
  • Phone: 302-427-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberGI0001087
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: