Mid- Atlantic Dental Partners Delaware III, PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MID- ATLANTIC DENTAL PARTNERS DELAWARE III, PA

Practice address

4133 Ogletown Stanton Rd
Newark, DE 19713-4168

Phone

(484) 455-4550

Fax

(484) 284-5102

NPI assigned

May 8, 2019

Organization subpart

No

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

Authorized official

Name

Lorraine Allen

Title

Credentialing Manager

Phone

(484) 455-4550

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557273600000",
    "number": "1326603044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4133 OGLETOWN STANTON RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197134168",
            "telephone_number": "484-455-4550",
            "fax_number": "484-284-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4133 OGLETOWN STANTON RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197134168",
            "telephone_number": "484-455-4550",
            "fax_number": "484-284-5102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID- ATLANTIC DENTAL PARTNERS DELAWARE III, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-08",
        "last_updated": "2019-05-08",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "484-455-4550"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Etienne Joseph Mickiewicz
• Alan Micklin, M.D.
• Mid Atlantic Cardiovascular Prevention and Lifestyle Program LLC
• Mid Atlantic Care
• Mid Atlantic Dental Partners Delaware 1, PA
• Mid-Atlantic Behavioral Health, LLC
• Mid-Atlantic Care
• Mid-Atlantic Endoscopy Center, LLC
• Mid-Atlantic G.I. Consultants
• Mid-Atlantic Gi Consultants, P.a.

• Dental Clinic/Center in Newark, DE
• Providers in Newark, DE by specialty
• Dental Clinic/Center in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; 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.