Provider Demographics
NPI:1689015398
Name:D'ELIA, MINDI ALYSE (DMD, MSD, MED)
Entity Type:Individual
Prefix:DR
First Name:MINDI
Middle Name:ALYSE
Last Name:D'ELIA
Suffix:
Gender:F
Credentials:DMD, MSD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 W HUNT HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5244
Mailing Address - Country:US
Mailing Address - Phone:480-330-6817
Mailing Address - Fax:
Practice Address - Street 1:1714 W HUNT HWY
Practice Address - Street 2:STE 102
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143-5244
Practice Address - Country:US
Practice Address - Phone:480-330-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008783122300000X, 1223P0221X
WADR604637441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist