Provider Demographics
NPI:1528009479
Name:DELEO, JAMES P IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:DELEO
Suffix:IV
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 1:12 CHESTERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4850
Mailing Address - Country:US
Mailing Address - Phone:603-488-5880
Mailing Address - Fax:
Practice Address - Street 1:745 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3002
Practice Address - Country:US
Practice Address - Phone:603-622-7173
Practice Address - Fax:603-668-2709
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30301213Medicare ID - Type UnspecifiedHEALTHY KIDS GOLD