SOUTHERN DE ASSOCIATES OF ORAL & MAXILLOFACIAL SURGERY (NPI# 1063744795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063744795 |
| Entity Type | Organization |
| Organization Name | SOUTHERN DE ASSOCIATES OF ORAL & MAXILLOFACIAL SURGERY |
| Practice Address |
126 West Front St. Frederica DE 19946 |
| Mailing Address |
Po Box 266 Frederica DE 19946-0266 |
| Practice Telephone | 3023352601 |
| Practice Fax Number | 3023352603 |
| Mailing Telephone | 3023352601 |
| Mailing Fax Number | 3023352603 |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2010-02-05 |
| Authorized Official Name | ALLISON KOWALCHICK (OFFICE MANAGER) |
| Authorized Official Telephone | 3026447654 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
2010600241 | DE | Dental Providers |
| Street Address |
126 WEST FRONT ST. |
| City | FREDERICA |
| State | DE |
| Zip Code | 19946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164969085 | Jonathan Wenk | Adult Companion | 6 North Market St, Frederica, DE 19946 | 2017-01-30 |
| 1477910099 | Patricia Licausi | Student in an Organized Health Care Education/Training Program | 3148 Main Street, Frederica, DE 19946 | 2016-01-27 |
| 1245624329 | Michelle Marie Johnston | Counselor | 124 West Front Street, Frederica, DE 19946 | 2015-03-26 |
| 1477823888 | Patricia Ann Groff | Nurse's Aide | 3544 Main Street, Frederica, DE 19946 | 2012-01-03 |
| 1518064815 | Bowers Fire Company Inc | Ambulance | 3285 Main St, Frederica, DE 19946 | 2006-09-20 |
| 1295700425 | Teresa Deshawn Green | Physician Assistant | 1020 Forrest Avenue, Suite 1, Dover, DE 19946 | 2006-02-21 |
| 1326145624 | Frederica Volunteer Fire Company | Ambulance | 2 Front St, Frederica, DE 19946 | 2006-09-20 |
| 1154301612 | Lieba T Kaplan | Social Worker | 224 N Bay Shore Drive, Bowers Beach, DE 19946-1206 | 2006-01-20 |
| 1316544661 | Addineka Cole | Psychologist | 298 Waterway Dr, Frederica, DE 19946-2126 | 2020-10-08 |
| 1912434721 | Caitlin Pepper | Counselor | 263 Sweeping Mist Cir, Frederica, DE 19946-2408 | 2017-05-11 |
| Find all providers in zip 19946 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548705197 | Petrunich Oral Surgery | Dentist | 2444 Pulaski Hwy # 100, Newark, DE 19702-3906 | 2017-01-05 |
| 1972948198 | Michael David D'amico | Dentist | 4735 Ogletown Stanton Rd Ste 1115, Newark, DE 19713-2089 | 2013-05-01 |
| 1801001516 | David Dieu | Dentist | 1202 Foulk Road, Wilmington, DE 19803 | 2007-05-14 |
| 1598889438 | Samuel C Nwogu | Dentist | 200 Biddle Ave Ste 214, Newark, DE 19702-3966 | 2007-03-17 |
| 1033257530 | Douglas Lynn Ditty | Dentist | 1004 S State St Ste 1, Dover, DE 19901-6901 | 2007-02-05 |
| 1558452177 | Oral & Maxillofacial Surgery Associates, P.a. | Dentist | 1304 N Broom St, Wilmington, DE 19806-4254 | 2006-09-27 |
| 1437250008 | Norman M Lippman | Dentist | 712 S Governors Ave, Dover, DE 19904 | 2006-09-26 |
| 1982625547 | David B. Ettinger | Dentist | 131 E Chestnut Hill Rd, Newark, DE 19713-4043 | 2006-07-21 |
| 1912940602 | Peter Francis Subach | Dentist | 1601 Milltown Rd Suite 17, Wilmington, DE 19808 | 2006-06-13 |
| 1407803398 | Otto Frederick Tidwell | Dentist | 19323 Lighthouse Plaza Blvd, Unit 4, Rehoboth Beach, DE 19971-6162 | 2006-05-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.