Organization
FIRST STATE ORAL AND MAXILLOFACIAL SURGERY CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS LYNN DITTY DMD, MD (OWNER)
(302) 674-4450
Entity
Organization
Contact information
Practice address
1004 S STATE ST STE 1, DOVER, DE 19901-6901
(302) 674-4450
(302) 678-3228
Mailing address
1004 S STATE ST STE 1, DOVER, DE 19901-6901
(302) 674-4450
(302) 678-3228
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
G100093
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000039185
—
DE
Enumeration date
03/28/2007
Last updated
11/05/2019
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