Healthcare Provider Details

I. General information

NPI: 1215670468
Provider Name (Legal Business Name): GUSTAVO A DELGADO DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 SMITH CORNERS BLVD STE 600
CHARLOTTE NC
28269-3769
US

IV. Provider business mailing address

7340 SMITH CORNERS BLVD STE 600
CHARLOTTE NC
28269-3769
US

V. Phone/Fax

Practice location:
  • Phone: 910-387-2126
  • Fax:
Mailing address:
  • Phone: 910-387-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN TUINEI
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 602-750-6897