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General NPI Number Information
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NPI Number | 1699235937
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Entity Type | Organization
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Legal Business Name | BRANDYWINE PEDIATRIC DENTISTRY, P.A.
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 2000 FOULK RD STE C
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City | WILMINGTON
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State | DE
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Zip | 19810-3642
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Country | US
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Telephone | 302-475-3110
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Fax | 302-475-5206
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Provider Business Mailing Address
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Address Line | 2000 FOULK RD STE C
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City | WILMINGTON
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State | DE
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Zip | 19810-3642
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Country | US
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Telephone | 302-475-3110
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. JILL L GARRIDO
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Credential | DDS
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Telephone | 302-475-3110
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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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