| First State Oral And Maxillofacial Surgery Corp | |
|
1004 S State St Ste 1 Dover DE 19901-6901 | |
| (302) 674-4450 | |
| (302) 678-3228 |
| Full Name | First State Oral And Maxillofacial Surgery Corp |
|---|---|
| Speciality | Dentist |
| Location | 1004 S State St Ste 1, Dover, Delaware |
| Authorized Official Name and Position | Douglas Lynn Ditty (OWNER) |
| Authorized Official Contact | 3026744450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First State Oral And Maxillofacial Surgery Corp 1004 S State St Ste 1 Dover DE 19901-6901 Ph: (302) 674-4450 | First State Oral And Maxillofacial Surgery Corp 1004 S State St Ste 1 Dover DE 19901-6901 Ph: (302) 674-4450 |
| NPI Number | 1922127232 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 11/05/2019 |
| Medicare PECOS PAC ID | 9638245947 |
|---|---|
| Medicare Enrollment ID | O20080911000187 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922127232 | NPI | - | NPPES |
| 1000039185 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | G100093 (Delaware) | Primary |
| Provider Name | Eric W Spencer |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790947265 PECOS PAC ID: 5294014106 Enrollment ID: I20161117000709 |
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