# DELAWARE TONGUE TIE CENTER

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

## Provider details

- **NPI number:** 1750962619
- **Authorized official:** DR. GERARDO MARTINEZ DMD (PEDIATRIC DENTISTRY)
- **Authorized official phone:** (954) 330-1525

## Contact information

- **Practice address:** 625 N DUPONT BLVD, MILFORD, DE 19963-1099
- **Practice address phone:** (954) 330-1525
- **Mailing address:** 628 SPRING HOLLOW DR, MIDDLETOWN, DE 19709-7817
- **Mailing address phone:** (305) 321-5162

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |
| 2080S0012X | Pediatric Sleep Medicine Physician | — | NULL | Yes |
| 2080S0012X | Pediatric Sleep Medicine Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 2251P0200X | Pediatric Physical Therapist | — | NULL | — |
| 2251P0200X | Pediatric Physical Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 04/20/2021
- **Last updated:** 04/20/2021