Provider Demographics
NPI:1023272119
Name:BEND ORAL, FACIAL, AND IMPLANT SURGERY
Entity type:Organization
Organization Name:BEND ORAL, FACIAL, AND IMPLANT SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DELISI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-383-6515
Mailing Address - Street 1:431 NE REVERE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4192
Mailing Address - Country:US
Mailing Address - Phone:541-383-6515
Mailing Address - Fax:
Practice Address - Street 1:431 NE REVERE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4192
Practice Address - Country:US
Practice Address - Phone:541-383-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty