Provider Demographics
NPI:1639329337
Name:DELISLE, STEVEN ELIOT (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ELIOT
Last Name:DELISLE
Suffix:
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 1:4090 N MLK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-3218
Mailing Address - Country:US
Mailing Address - Phone:425-306-2579
Mailing Address - Fax:
Practice Address - Street 1:4090 N MLK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3218
Practice Address - Country:US
Practice Address - Phone:425-306-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7848122300000X
NV5929122300000X
CA565631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5929OtherDENTAL LICENSE
CA56563OtherSTATE LICENSE
AZ7848OtherSTATE DENTAL LICENSE