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General NPI Number Information
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NPI Number | 1013386697
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Entity Type | Organization
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Legal Business Name | PROSPEROUS, LLC
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Dates
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Enumeration Date | 09/24/2015
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 25935 PLAZA DR
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City | MILLSBORO
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State | DE
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Zip | 19966-6289
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Country | US
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Telephone | 302-947-4111
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Fax | 302-595-3149
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Provider Business Mailing Address
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Address Line | PO BOX 1165
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City | MIDDLETOWN
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State | DE
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Zip | 19709-7165
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Country | US
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Telephone | 267-559-3001
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Fax | 302-595-3149
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Authorized Official
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Title or Position | MANAGING MEMEBER
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Name | MARIAM FOUZIA
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Credential |
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Telephone | 267-559-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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