Healthcare Provider Details

I. General information

NPI: 1093818197
Provider Name (Legal Business Name): GEORGE DELGADO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 INGLESIDE AVE
BALTIMORE MD
21228-1317
US

IV. Provider business mailing address

1006 INGLESIDE AVE
BALTIMORE MD
21228-1317
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-1707
  • Fax: 410-747-2608
Mailing address:
  • Phone: 410-747-1707
  • Fax: 410-747-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberMD5889
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: