Provider Demographics
NPI:1609082973
Name:DELIO, DAMIEN ANTHONY
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:ANTHONY
Last Name:DELIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 DEEP VALLEY DR
Mailing Address - Street 2:#302
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3647
Mailing Address - Country:US
Mailing Address - Phone:310-377-6895
Mailing Address - Fax:310-541-1975
Practice Address - Street 1:827 DEEP VALLEY DR.
Practice Address - Street 2:#302
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90227
Practice Address - Country:US
Practice Address - Phone:310-377-6895
Practice Address - Fax:310-541-1675
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics