Provider Demographics
NPI:1568798874
Name:STEVEN DELISLE DDS P.C.
Entity Type:Organization
Organization Name:STEVEN DELISLE DDS P.C.
Other - Org Name:SEDATION DENTAL CENTER OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-306-2579
Mailing Address - Street 1:2480 E TOMPKINS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7394
Mailing Address - Country:US
Mailing Address - Phone:425-306-2579
Mailing Address - Fax:888-583-4140
Practice Address - Street 1:4080 N MARTIN L KING BLVD
Practice Address - Street 2:SUITE 101 B
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3216
Practice Address - Country:US
Practice Address - Phone:425-306-2579
Practice Address - Fax:888-583-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV59291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV22Medicaid