Provider Demographics
NPI:1689232480
Name:DELPONT, JOHN AUSTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:AUSTIN
Last Name:DELPONT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 TUCKER WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6258
Mailing Address - Country:US
Mailing Address - Phone:270-781-2952
Mailing Address - Fax:270-793-0977
Practice Address - Street 1:1857 TUCKER WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6258
Practice Address - Country:US
Practice Address - Phone:270-781-2952
Practice Address - Fax:270-793-0977
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice