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NPI 1033914692

NPI 1033914692 : DENTISTRYONE OF DELAWARE ERIC WESTERGARD PA : WILMINGTON, DE

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General NPI Number Information
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    NPI Number           |    1033914692
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    Entity Type          |    Organization 
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    Legal Business Name  |    DENTISTRYONE OF DELAWARE ERIC WESTERGARD PA 
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Dates
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    Enumeration Date     |    02/18/2025
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    Last Update Date     |    05/13/2025
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Provider Practice Location Address
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    Address Line         |    1401 PENNSYLVANIA AVE STE 105 
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    City                 |    WILMINGTON
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    State                |    DE
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    Zip                  |    19806-4125
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    Country              |    US
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    Telephone            |    877-712-7875
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    20 HIGHLAND AVE 
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    City                 |    METUCHEN
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    State                |    NJ
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    Zip                  |    08840-1949
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     ERIC  WESTERGARD 
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    Credential           |    
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    Telephone            |    877-712-7875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    1223P0221X
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    Taxonomy Name        |    Pediatric Dentistry
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    License Number       |    
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    License Number State |    
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Taxonomy #2
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    Taxonomy Code        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    
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    License Number State |    
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