NPIMap

Organization Active NPI

Southern Delaware Associates of Dental Specialities

  • Oral and Maxillofacial Surgery Clinic/Center
  • Rehoboth Beach, DE
National Provider Identifier
1952687360
Registry record updated Oct 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
Legal business name
SOUTHERN DELAWARE ASSOCIATES OF DENTAL SPECIALITIES
Practice address
19323 Lighthouse Plaza Blvd
Unit 4
Rehoboth Beach, DE 19971-6162
Phone
(215) 880-9919
NPI assigned
Oct 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2011

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

Authorized official

Name
Otto Tidwell, DDSNPI 1407803398
Title
Owner
Phone
(215) 880-9919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X DE Primary

Addresses

Primary practice location

19323 Lighthouse Plaza Blvd
Unit 4
Rehoboth Beach, DE 19971-6162

Mailing address

19323 Lighthouse Plaza Blvd
Unit 4
Rehoboth Beach, DE 19971-6162
Phone (215) 880-9919

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1319932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319932800000",
    "number": "1952687360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19323 LIGHTHOUSE PLAZA BLVD",
            "address_2": "UNIT 4",
            "city": "REHOBOTH BEACH",
            "state": "DE",
            "postal_code": "199716162",
            "telephone_number": "215-880-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19323 LIGHTHOUSE PLAZA BLVD",
            "address_2": "UNIT 4",
            "city": "REHOBOTH BEACH",
            "state": "DE",
            "postal_code": "199716162",
            "telephone_number": "215-880-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DELAWARE ASSOCIATES OF DENTAL SPECIALITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-30",
        "last_updated": "2011-10-30",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "OTTO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-880-9919",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "DE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rehoboth Beach, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2011; 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.