Provider Demographics
NPI:1629773247
Name:CHRISTIANA CENTER FOR ORAL & MAXILLOFACIAL SURGERY, P.A.
Entity type:Organization
Organization Name:CHRISTIANA CENTER FOR ORAL & MAXILLOFACIAL SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-328-6777
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-0049
Mailing Address - Country:US
Mailing Address - Phone:302-328-6777
Mailing Address - Fax:302-292-8629
Practice Address - Street 1:2005 CONCORD PIKE STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2982
Practice Address - Country:US
Practice Address - Phone:302-292-1600
Practice Address - Fax:302-292-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty