# FIRST STATE ORAL AND MAXILLOFACIAL SURGERY CORP

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

## Provider details

- **NPI number:** 1922127232
- **Authorized official:** DR. DOUGLAS LYNN DITTY DMD, MD (OWNER)
- **Authorized official phone:** (302) 674-4450

## Contact information

- **Practice address:** 1004 S STATE ST STE 1, DOVER, DE 19901-6901
- **Practice address phone:** (302) 674-4450
- **Practice address fax:** (302) 678-3228
- **Mailing address:** 1004 S STATE ST STE 1, DOVER, DE 19901-6901
- **Mailing address phone:** (302) 674-4450
- **Mailing address fax:** (302) 678-3228

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | G100093 | DE | Yes |

## Other

- **Enumeration date:** 03/28/2007
- **Last updated:** 11/05/2019