Healthcare Provider Details

I. General information

NPI: 1952661902
Provider Name (Legal Business Name): PETER F. SUBACH DMD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MILLTOWN RD SUITE#17
WILMINGTON DE
19808-4027
US

IV. Provider business mailing address

1601 MILLTOWN RD SUITE#17
WILMINGTON DE
19808-4027
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberG10001087
License Number StateDE

VIII. Authorized Official

Name: DR. PETER F. SUBACH
Title or Position: PRESIDENT
Credential: DMD
Phone: 302-995-1870