Provider Demographics
NPI:1043427040
Name:DILIZIA, CAMILLO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLO
Middle Name:
Last Name:DILIZIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16981 E QUINCY AVE
Mailing Address - Street 2:#D1-D3
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2769
Mailing Address - Country:US
Mailing Address - Phone:303-617-8400
Mailing Address - Fax:303-617-3516
Practice Address - Street 1:15930 RED BUD DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4142
Practice Address - Country:US
Practice Address - Phone:720-318-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7536122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34131540Medicaid