First State Oral and Maxillofacial Surgery Corp

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

G100093 Issued in DE

Legal business name

FIRST STATE ORAL AND MAXILLOFACIAL SURGERY CORP

Practice address

1004 S State St Ste 1
Dover, DE 19901-6901

Phone

(302) 674-4450

Fax

(302) 678-3228

NPI assigned

Mar 28, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Douglas Lynn Ditty, DMD, MD

Title

Owner

Phone

(302) 674-4450

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DE

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eric W Spencer

  • Oral and Maxillofacial Surgery (Dentist)
  • Newark, DE
  • NPI 1790947265

  DE, Oral and Maxillofacial Surgery

  Medicare reassignment NPD
• Jennifer Caughey

  • Oral and Maxillofacial Surgery (Dentist)
  • Dover, DE
  • NPI 1114488772

  Oral and Maxillofacial Surgery

  NPD (past)
• Otto Frederick Tidwell, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Rehoboth Beach, DE
  • NPI 1407803398

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572912000000",
    "number": "1922127232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 S STATE ST STE 1",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199016901",
            "telephone_number": "302-674-4450",
            "fax_number": "302-678-3228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 S STATE ST STE 1",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199016901",
            "telephone_number": "302-674-4450",
            "fax_number": "302-678-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST STATE ORAL AND MAXILLOFACIAL SURGERY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2019-11-05",
        "status": "A",
        "authorized_official_last_name": "DITTY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-674-4450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "DE",
            "license": "G100093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000039185",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• First State DME LLC
• First State Gastroenterology Association
• First State Imaging
• First State Infectious Diseases, LLC
• First State Infectious Diseases, LLC
• First State Orthopaedics PA
• First State Orthopaedics PA
• First State Orthopaedics, PA
• First State Orthopaedics, PA
• First State Orthopaedics, PA

• All providers in Dover, DE
• Oral and Maxillofacial Surgery (Dentist) in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.