Healthcare Provider Details

I. General information

NPI: 1639329337
Provider Name (Legal Business Name): STEVEN ELIOT DELISLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 GLACIER DR STE 107
LOLO MT
59847-9343
US

IV. Provider business mailing address

116 GLACIER DR STE 107
LOLO MT
59847-9343
US

V. Phone/Fax

Practice location:
  • Phone: 406-515-9655
  • Fax:
Mailing address:
  • Phone: 406-515-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number11540
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11540
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: