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General NPI Number Information
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NPI Number | 1275044612
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Entity Type | Organization
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Legal Business Name | DELAWARE PERIODONTICS AND IMPLANTS LLC
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 2300 PENNSYLVANIA AVE UNIT 5D
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City | WILMINGTON
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State | DE
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Zip | 19806-1392
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Country | US
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Telephone | 302-652-1533
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 PENNSYLVANIA AVE UNIT 5D
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City | WILMINGTON
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State | DE
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Zip | 19806-1392
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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 | MEMBER
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Name | DR. JAVIER DANIEL SANZ MOLINER
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Credential |
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Telephone | 703-307-7789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | G10001370
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License Number State | DE
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