| Southern De Oral And Maxillofacial Surgery Associates, Pa | |
|
17605 Nassau Commons Blvd Ste C Lewes DE 19958-6284 | |
| (302) 644-2977 | |
| (302) 645-7561 |
| Full Name | Southern De Oral And Maxillofacial Surgery Associates, Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 17605 Nassau Commons Blvd Ste C, Lewes, Delaware |
| Authorized Official Name and Position | Bruce D Fisher (OWNER) |
| Authorized Official Contact | 3026442977 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern De Oral And Maxillofacial Surgery Associates, Pa 17605 Nassau Commons Blvd Ste C Lewes DE 19958-6284 Ph: (302) 644-2977 | Southern De Oral And Maxillofacial Surgery Associates, Pa 17605 Nassau Commons Blvd Ste C Lewes DE 19958-6284 Ph: (302) 644-2977 |
| NPI Number | 1629144589 |
|---|---|
| Provider Enumeration Date | 11/24/2006 |
| Last Update Date | 06/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629144589 | NPI | - | NPPES |
| 1000015026 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 2000106563 (Delaware) | Primary |
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