Healthcare Provider Details

I. General information

NPI: 1528061421
Provider Name (Legal Business Name): JON M. DELSNYDER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/05/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S RURAL RD STE 1
TEMPE AZ
85283-3793
US

IV. Provider business mailing address

6655 S RURAL RD STE 1
TEMPE AZ
85283-3793
US

V. Phone/Fax

Practice location:
  • Phone: 602-346-9775
  • Fax:
Mailing address:
  • Phone: 602-346-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7114
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberD7114
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: