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General NPI Number Information
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NPI Number | 1568798874
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Entity Type | Organization
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Legal Business Name | STEVEN DELISLE DDS P.C.
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 4080 N MARTIN L KING BLVD SUITE 101 B
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City | N LAS VEGAS
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State | NV
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Zip | 89032-3216
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Country | US
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Telephone | 425-306-2579
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Fax | 888-583-4140
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Provider Business Mailing Address
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Address Line | 2480 E TOMPKINS AVE SUITE 102
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City | LAS VEGAS
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State | NV
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Zip | 89121-7394
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Country | US
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Telephone | 425-306-2579
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Fax | 888-583-4140
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN DELISLE
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Credential | DDS
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Telephone | 425-306-2579
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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 | 5929
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License Number State | NV
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