Provider Demographics
NPI:1912940602
Name:SUBACH, PETER FRANCIS (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:FRANCIS
Last Name:SUBACH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HOBSON DR
Mailing Address - Street 2:WEST RIDING
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707
Mailing Address - Country:US
Mailing Address - Phone:302-427-9404
Mailing Address - Fax:
Practice Address - Street 1:1601 MILLTOWN RD SUITE 17
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-995-1870
Practice Address - Fax:302-995-9568
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEGI00010871223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A187L88Medicare ID - Type Unspecified
U85107Medicare UPIN