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General NPI Number Information
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NPI Number | 1932693777
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Entity Type | Organization
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Legal Business Name | DELAWARE DENTAL STUDIO LLC
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Dates
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Enumeration Date | 06/15/2018
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Last Update Date | 06/15/2018
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Provider Practice Location Address
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Address Line | 2500 GRUBB RD STE 130
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City | WILMINGTON
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State | DE
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Zip | 19810-4711
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Country | US
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Telephone | 408-656-0391
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Fax |
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Provider Business Mailing Address
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Address Line | 2102 WOODLAWN AVE
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City | WILMINGTON
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State | DE
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Zip | 19806-2236
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Country | US
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Telephone | 408-656-0391
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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. LYNN ZELIGS FEE
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Credential | DDS
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Telephone | 408-656-0391
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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 | G1-0001387
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License Number State | DE
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