Provider Demographics
NPI:1326194739
Name:DELISLE, DANIEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:DELISLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066
Mailing Address - Country:US
Mailing Address - Phone:937-748-9125
Mailing Address - Fax:937-748-9126
Practice Address - Street 1:780 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066
Practice Address - Country:US
Practice Address - Phone:937-748-9125
Practice Address - Fax:937-748-9126
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist