Provider Demographics
NPI:1699861963
Name:FAMILY DENTISTRY OF MILFORD PA
Entity type:Organization
Organization Name:FAMILY DENTISTRY OF MILFORD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BAUSCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-422-6924
Mailing Address - Street 1:100 SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1823
Mailing Address - Country:US
Mailing Address - Phone:302-422-6924
Mailing Address - Fax:302-422-6768
Practice Address - Street 1:100 SUSSEX AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1823
Practice Address - Country:US
Practice Address - Phone:302-422-6924
Practice Address - Fax:302-422-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE19918361161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty