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General NPI Number Information
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NPI Number | 1639329337
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Entity Type | Individual
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Provider Name | STEVEN ELIOT DELISLE DDS
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Gender | Male
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 4090 N MLK BLVD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-3218
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Country | US
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Telephone | 425-306-2579
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Fax |
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Provider Business Mailing Address
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Address Line | 4090 N MLK BLVD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-3218
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Country | US
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Telephone | 425-306-2579
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 7848
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5929
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 56563
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License Number State | CA
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