Provider Demographics
NPI:1508866625
Name:TIO, DELFIN (DDS)
Entity Type:Individual
Prefix:
First Name:DELFIN
Middle Name:
Last Name:TIO
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 1:209 S OAKLAND AVE
Mailing Address - Street 2:#B
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2864
Mailing Address - Country:US
Mailing Address - Phone:626-792-9533
Mailing Address - Fax:626-444-2086
Practice Address - Street 1:2001 SANTA ANITA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3442
Practice Address - Country:US
Practice Address - Phone:626-443-3915
Practice Address - Fax:626-444-2086
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice