Organization
SOUTHERN DE ASSOCIATES OF ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON KOWALCHICK (OFFICE MANAGER)
(302) 644-7654
Entity
Organization
Contact information
Practice address
126 WEST FRONT ST., FREDERICA, DE 19946
(302) 335-2601
(302) 335-2603
Mailing address
PO BOX 266, FREDERICA, DE 19946-0266
(302) 335-2601
(302) 335-2603
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2010600241
DE
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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