Provider Demographics
NPI:1598997967
Name:DELIMA, LUIS FERNANDO JR (DDS, FACP)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FERNANDO
Last Name:DELIMA
Suffix:JR
Gender:M
Credentials:DDS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 FRANCE AVE S STE 680
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2127
Mailing Address - Country:US
Mailing Address - Phone:952-922-5326
Mailing Address - Fax:952-922-5367
Practice Address - Street 1:6545 FRANCE AVE S STE 680
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2127
Practice Address - Country:US
Practice Address - Phone:952-922-5326
Practice Address - Fax:952-922-5367
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNS461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics