Provider Demographics
NPI:1013447283
Name:DELGADO, GUSTAVO ANDRES (DMD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ANDRES
Last Name:DELGADO
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 1:424 ROCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0076
Mailing Address - Country:US
Mailing Address - Phone:910-381-2126
Mailing Address - Fax:
Practice Address - Street 1:2331 CROWNPOINT EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7749
Practice Address - Country:US
Practice Address - Phone:704-705-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice