Organization
SOUTHERN DELAWARE ASSOCIATES OF DENTAL SPECIALITIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OTTO TIDWELL DDS (OWNER)
(215) 880-9919
Entity
Organization
Contact information
Practice address
19323 LIGHTHOUSE PLAZA BLVD, UNIT 4, REHOBOTH BEACH, DE 19971-6162
(215) 880-9919
Mailing address
19323 LIGHTHOUSE PLAZA BLVD, UNIT 4, REHOBOTH BEACH, DE 19971-6162
(215) 880-9919
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
DE
Other
Enumeration date
10/30/2011
Last updated
10/30/2011
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