Provider Demographics
NPI:1649506551
Name:DELAWARE DENTAL PARTNERS, LLP.
Entity type:Organization
Organization Name:DELAWARE DENTAL PARTNERS, LLP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-362-2202
Mailing Address - Street 1:1179 COLUMBUS PIKE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2713
Mailing Address - Country:US
Mailing Address - Phone:740-362-2202
Mailing Address - Fax:740-362-2204
Practice Address - Street 1:1179 COLUMBUS PIKE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2713
Practice Address - Country:US
Practice Address - Phone:740-362-2202
Practice Address - Fax:740-362-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH221171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty