MEDICARE: STEVEN DELISLE PLLC

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
1	261QD0000X	Dental Clinic/Center	5929	NV

General Provider Information

NPI Number	:	1568757896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN DELISLE PLLC

Provider Business Mailing Address
First Line	:	2585 S JONES BLVD STE 1A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2585 S JONES BLVD STE 1A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5604
Country	:	US
Telephone Number	:	702-489-5460
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN DELISLE
Credential	:	DDS
Telephone Number	:	425-306-2579

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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