# SOUTHERN DE ASSOCIATES OF ORAL & MAXILLOFACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063744795
- **Authorized official:** ALLISON KOWALCHICK (OFFICE MANAGER)
- **Authorized official phone:** (302) 644-7654

## Contact information

- **Practice address:** 126 WEST FRONT ST., FREDERICA, DE 19946
- **Practice address phone:** (302) 335-2601
- **Practice address fax:** (302) 335-2603
- **Mailing address:** PO BOX 266, FREDERICA, DE 19946-0266
- **Mailing address phone:** (302) 335-2601
- **Mailing address fax:** (302) 335-2603

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2010600241 | DE | Yes |

## Other

- **Enumeration date:** 02/05/2010
- **Last updated:** 02/05/2010