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General NPI Number Information
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NPI Number | 1629514492
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Entity Type | Individual
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Provider Name | BRIAN J. DELISLE, DDS DDS
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Gender | Male
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Dates
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Enumeration Date | 01/17/2017
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 11414 SEMINOLE BLVD STE 2
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City | LARGO
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State | FL
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Zip | 33778-3200
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Country | US
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Telephone | 727-398-5829
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Fax | 727-394-2828
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Provider Business Mailing Address
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Address Line | 11414 SEMINOLE BLVD STE 2
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City | LARGO
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State | FL
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Zip | 33778-3200
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Country | US
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Telephone | 727-398-5829
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Fax | 727-394-2828
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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 | DN0011245
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License Number State | FL
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