| Delaware Modern Dental | |
|
850 Library Ave Suite 102 Newark DE 19711-7170 | |
| (302) 366-8668 | |
| (302) 366-8081 |
| Full Name | Delaware Modern Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 850 Library Ave, Newark, Delaware |
| Authorized Official Name and Position | Lisa Fagioletti (DENTIST) |
| Authorized Official Contact | 3023668668 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Delaware Modern Dental 850 Library Ave Suite 102 Newark DE 19711-7170 Ph: (302) 366-8668 | Delaware Modern Dental 850 Library Ave Suite 102 Newark DE 19711-7170 Ph: (302) 366-8668 |
| NPI Number | 1265585046 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265585046 | NPI | - | NPPES |
| 1000037168 | Medicaid | DE | |
| 1000036904 | Medicaid | DE | |
| 1000028544 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2005207645 (Delaware) | Primary |
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