Provider Demographics
NPI:1316179765
Name:DELHI DENTAL CLINIC
Entity Type:Organization
Organization Name:DELHI DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-878-2405
Mailing Address - Street 1:516 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:LA
Mailing Address - Zip Code:71232-2538
Mailing Address - Country:US
Mailing Address - Phone:318-878-2405
Mailing Address - Fax:318-878-8968
Practice Address - Street 1:516 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:LA
Practice Address - Zip Code:71232-2538
Practice Address - Country:US
Practice Address - Phone:318-878-2405
Practice Address - Fax:318-878-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty