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General NPI Number Information
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NPI Number | 1588633515
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Entity Type | Individual
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Provider Name | DONALD CHARLES DELISI JR. D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 19785 VILLAGE OFFICE CT STE 102
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City | BEND
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State | OR
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Zip | 97702-1944
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Country | US
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Telephone | 541-383-6515
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Fax | 541-383-1488
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Provider Business Mailing Address
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Address Line | 2584 NE KEVOS POND DR
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City | POULSBO
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State | WA
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Zip | 98370-6320
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Country | US
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Telephone | 360-649-7625
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Fax |
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE00010134
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D7889
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License Number State | OR
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