Organization
DELAWARE MODERN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA FAGIOLETTI D.M.D. (DENTIST)
(302) 366-8668
Entity
Organization
Contact information
Practice address
850 LIBRARY AVE, SUITE 102, NEWARK, DE 19711-7170
(302) 366-8668
(302) 366-8081
Mailing address
850 LIBRARY AVE, SUITE 102, NEWARK, DE 19711-7170
(302) 366-8668
(302) 366-8081
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2005207645
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000028544
—
DE
05
—
1000036904
—
DE
05
—
1000037168
—
DE
Enumeration date
01/18/2007
Last updated
08/22/2020
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