Healthcare Provider Details

I. General information

NPI: 1972970911
Provider Name (Legal Business Name): DELIO ORTHODONTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 DEEP VALLEY DR SUITE 302
ROLLING HILLS ESTATES CA
90274-3647
US

IV. Provider business mailing address

827 DEEP VALLEY DR SUITE 302
ROLLING HILLS ESTATES CA
90274-3647
US

V. Phone/Fax

Practice location:
  • Phone: 310-377-6895
  • Fax:
Mailing address:
  • Phone: 310-377-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number39143
License Number StateCA

VIII. Authorized Official

Name: DR. DAMIEN A DELIO
Title or Position: OWNER
Credential: D.D.S.
Phone: 310-377-6895