MEDICARE: STEVEN DELISLE DDS P.C.

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	1223G0001X	General Practice Dentistry	5929	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568798874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN DELISLE DDS P.C.

Provider Business Mailing Address
First Line	:	2480 E TOMPKINS AVE
Second Line	:	SUITE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7394
Country	:	US
Telephone Number	:	425-306-2579
Fax Number	:	888-583-4140

Provider Business Practice Location Address
First Line	:	4080 N MARTIN L KING BLVD
Second Line	:	SUITE 101 B
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-3216
Country	:	US
Telephone Number	:	425-306-2579
Fax Number	:	888-583-4140

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	09/19/2016

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