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General NPI Number Information
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NPI Number | 1306311519
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Entity Type | Organization
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Legal Business Name | CONCORD DENTAL, LLC
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 2304 CONCORD PIKE
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City | WILMINGTON
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State | DE
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Zip | 19803-2912
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Country | US
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Telephone | 302-791-3750
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 PEOPLES PLZ
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City | NEWARK
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State | DE
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Zip | 19702-5701
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Country | US
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Telephone | 302-392-2490
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | GLEN GOLEBURN
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Credential | DMD
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Telephone | 302-836-3750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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