Healthcare Provider Details

I. General information

NPI: 1639243256
Provider Name (Legal Business Name): DELIMA & NGUYEN, D.M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 CHARLES STREET
HOLLISTON MA
01746
US

IV. Provider business mailing address

71 CHARLES STREET
HOLLISTON MA
01746
US

V. Phone/Fax

Practice location:
  • Phone: 508-429-5500
  • Fax: 508-429-3413
Mailing address:
  • Phone: 508-429-5500
  • Fax: 508-429-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20032
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number19190
License Number StateMA

VIII. Authorized Official

Name: DR. HEATHER NGUYEN
Title or Position: GENERAL PARTNER
Credential: DMD
Phone: 508-429-5500