Healthcare Provider Details

I. General information

NPI: 1104205772
Provider Name (Legal Business Name): KAREN JO DELANEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 MAIN ST
CALAIS ME
04619-1859
US

IV. Provider business mailing address

254 SOUTH ST
CALAIS ME
04619-1322
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-2350
  • Fax: 207-454-2897
Mailing address:
  • Phone: 207-454-2350
  • Fax: 207-454-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN4422
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDEN4422
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: