Healthcare Provider Details

I. General information

NPI: 1376730135
Provider Name (Legal Business Name): EMMANUEL OLUTAYO DELANO BDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1CL & 1CP ESTATE DIAMOND
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

PO BOX 6073
CHRISTIANSTED VI
00823-6073
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-3636
  • Fax: 340-719-3636
Mailing address:
  • Phone: 340-778-3636
  • Fax: 340-719-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1221
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1221
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: