Provider Demographics
NPI:1033237342
Name:DELGADO, JOSE ERNESTO (DDS, DMD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ERNESTO
Last Name:DELGADO
Suffix:
Gender:M
Credentials:DDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 HARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6672
Mailing Address - Country:US
Mailing Address - Phone:734-272-8358
Mailing Address - Fax:
Practice Address - Street 1:3768 PACKARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2090
Practice Address - Country:US
Practice Address - Phone:734-975-0100
Practice Address - Fax:734-975-2509
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist