=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790010510
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DELIA S DOWNING D.D.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2009
-----------------------------------------------------
Last Update Date | 10/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 MAIN ST
-----------------------------------------------------
City | GOSHEN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10924-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-294-0516
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 DALEY LN
-----------------------------------------------------
City | WASHINGTONVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10992-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-496-8431
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 041776-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------