NPIMap

Organization Active NPI

Peninsula Dental, LLC

  • General Practice Dentistry
  • Millsboro, DE
National Provider Identifier
1013145366
Registry record updated Jun 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2009603113 Issued in DE
Legal business name
PENINSULA DENTAL, LLC
Practice address
26670 Centerview Dr Unit 19
Millsboro, DE 19966-3584
Phone
(302) 297-3750
NPI assigned
Jun 25, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John T. Moore
Title
Office Manager
Phone
(302) 297-3750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2009603113 DE Primary

Addresses

Primary practice location

26670 Centerview Dr Unit 19
Millsboro, DE 19966-3584

Mailing address

26670 Centerview Dr Unit 19
Millsboro, DE 19966-3584
Phone (302) 297-3750

National Provider Directory

National Provider Directory

Locations

26670 Centerview Dr
Unit 19
Millsboro, DE 19966
Phone (302) 297-3750

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245888000000",
    "number": "1013145366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26670 CENTERVIEW DR UNIT 19",
            "city": "MILLSBORO",
            "state": "DE",
            "postal_code": "199663584",
            "telephone_number": "302-297-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26670 CENTERVIEW DR UNIT 19",
            "city": "MILLSBORO",
            "state": "DE",
            "postal_code": "199663584",
            "telephone_number": "302-297-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-25",
        "last_updated": "2009-06-25",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "302-297-3750",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "2009603113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millsboro, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.