Healthcare Provider Details

I. General information

NPI: 1053980243
Provider Name (Legal Business Name): SYDNEY CHRISTINE DELGADILLO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 11TH ST
PORT BYRON IL
61275-9038
US

IV. Provider business mailing address

217 MARKET ST
GALVA IL
61434-1766
US

V. Phone/Fax

Practice location:
  • Phone: 309-523-3325
  • Fax:
Mailing address:
  • Phone: 309-932-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019033182
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: