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NPI Code Detail

MEDICARE: STEVEN DELISLE DDS PC

MEDICARE: STEVEN DELISLE DDS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist5929NV

General Provider Information

NPI Number : 1215447503
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEVEN DELISLE DDS PC
Provider Business Mailing Address
First Line : 2480 E TOMPKINS AVE STE 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5466
Country : US
Telephone Number : 702-524-5732
Fax Number :
Provider Business Practice Location Address
First Line : 1820 E LAKE MEAD BLVD STE G
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7134
Country : US
Telephone Number : 425-306-2579
Fax Number :
Authorized Official
Title or Position : C.O.O
Name : CINDY RODRIGUEZ
Credential :
Telephone Number : 702-524-5732
Provider Enumeration Date : 10/02/2017
Last Update Date : 03/17/2018

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