Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | GI-0001193 | DE |
NPI | 1033257530 |
---|---|
Provider Name | Dr. Douglas Lynn Ditty |
First Address | Dover, DE 19901-6925 |
Second Address | Dover, DE 19901-6901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 11/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000039259 | (05) | DE |
I47441 | (02) |