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General NPI Number Information
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NPI Number | 1639243256
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Entity Type | Organization
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Legal Business Name | DELIMA & NGUYEN, D.M.D.
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 71 CHARLES STREET
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City | HOLLISTON
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State | MA
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Zip | 01746
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Country | US
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Telephone | 508-429-5500
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Fax | 508-429-3413
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Provider Business Mailing Address
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Address Line | 71 CHARLES STREET
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City | HOLLISTON
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State | MA
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Zip | 01746
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Country | US
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Telephone | 508-429-5500
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Fax | 508-429-3413
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. HEATHER NGUYEN
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Credential | DMD
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Telephone | 508-429-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 19190
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20032
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License Number State | MA
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