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General NPI Number Information
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NPI Number | 1326194739
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Entity Type | Individual
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Provider Name | DANIEL A DELISLE DDS
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 780 NORTH MAIN STREET
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City | SPRINGBORO
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State | OH
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Zip | 45066
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Country | US
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Telephone | 937-748-9125
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Fax | 937-748-9126
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Provider Business Mailing Address
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Address Line | 780 NORTH MAIN STREET
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City | SPRINGBORO
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State | OH
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Zip | 45066
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Country | US
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Telephone | 937-748-9125
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Fax | 937-748-9126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30022265
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License Number State | OH
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