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General NPI Number Information
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NPI Number | 1013136738
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Entity Type | Organization
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Legal Business Name | J.MICHAEL FAY, D.D.S.,P.A.
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3105 LIMESTONE RD SUITE 304
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City | WILMINGTON
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State | DE
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Zip | 19808-2147
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Country | US
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Telephone | 302-998-2244
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Fax | 302-995-7134
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Provider Business Mailing Address
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Address Line | 3105 LIMESTONE RD SUITE 304
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City | WILMINGTON
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State | DE
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Zip | 19808-2147
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Country | US
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Telephone | 302-998-2244
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Fax | 302-995-7134
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK CHRISTOHER DELLOSE
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Credential | D.M.D.
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Telephone | 302-998-2244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEA#AF4127230
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License Number State | DE
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