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General NPI Number Information
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NPI Number | 1750962619
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Entity Type | Organization
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Legal Business Name | DELAWARE TONGUE TIE CENTER
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 625 N DUPONT BLVD
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City | MILFORD
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State | DE
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Zip | 19963-1099
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Country | US
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Telephone | 954-330-1525
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Fax |
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Provider Business Mailing Address
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Address Line | 628 SPRING HOLLOW DR
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City | MIDDLETOWN
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State | DE
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Zip | 19709-7817
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Country | US
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Telephone | 305-321-5162
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTISTRY
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Name | DR. GERARDO MARTINEZ
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Credential | DMD
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Telephone | 954-330-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics 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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2080S0012X
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Taxonomy Name | Pediatric Sleep Medicine Physician
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License Number |
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License Number State |
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