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General NPI Number Information
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NPI Number | 1083829618
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Entity Type | Organization
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Legal Business Name | DELGADO DENTAL INC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 8 W. SWAIN RD.
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City | STOCKTON
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State | CA
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Zip | 95207
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Country | US
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Telephone | 209-474-8888
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Fax | 209-474-3040
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Provider Business Mailing Address
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Address Line | 6207 EMBARCADERO DR.
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City | STOCKTON
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State | CA
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Zip | 95219
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Country | US
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Telephone | 209-957-7336
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JUAN PABLO DELGADO
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Credential | D.D.S.
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Telephone | 209-474-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 27514
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License Number State | CA
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