Provider Demographics
NPI:1285331603
Name:WILMINGTON PEDIATRIC DENTISTRY PA
Entity type:Organization
Organization Name:WILMINGTON PEDIATRIC DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIMORAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-641-7143
Mailing Address - Street 1:WILMINGTON PEDIATRIC DENTISTRY
Mailing Address - Street 2:3105 LIMESTONE RD SUITE 305
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-933-9900
Mailing Address - Fax:
Practice Address - Street 1:WILMINGTON PEDIATRIC DENTISTRY
Practice Address - Street 2:3105 LIMESTONE RD SUITE 305
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-933-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD800000233Medicaid