Provider Demographics
NPI:1629030994
Name:DELSOL, MARY ALICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALICIA
Last Name:DELSOL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:32241 CROWN VALLEY PKWY
Mailing Address - Street 2:STE. 220
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3346
Mailing Address - Country:US
Mailing Address - Phone:949-240-2280
Mailing Address - Fax:949-240-2619
Practice Address - Street 1:32241 CROWN VALLEY PKWY
Practice Address - Street 2:STE. 220
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3346
Practice Address - Country:US
Practice Address - Phone:949-240-2280
Practice Address - Fax:949-240-2619
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAD325441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD32544Medicare UPIN