Organization
COASTAL KIDS PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSICA S DI CERBO D.M.D. (PEDIATRIC DENTIST)
(610) 733-4300
Entity
Organization
Contact information
Practice address
18947 JOHN J WILLIAMS HWY, SUITE 309, REHOBOTH BEACH, DE 19971-4474
(610) 733-4300
Mailing address
18947 JOHN J WILLIAMS HWY, SUITE 309, REHOBOTH BEACH, DE 19971-4474
(610) 733-4300
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
G1-0001296
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171999
GUARDIAN
—
01
—
1821433145
DELTA DENTAL
—
05
—
1821433145
—
DE
01
—
271596
CIGNA
—
Enumeration date
04/30/2013
Last updated
05/04/2016
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