Provider Demographics
NPI:1831890540
Name:DELREAL, CODY PAUL (DDS)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:PAUL
Last Name:DELREAL
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 1:394 N OLD HAMMER ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-1765
Mailing Address - Country:US
Mailing Address - Phone:720-261-9932
Mailing Address - Fax:
Practice Address - Street 1:394 N OLD HAMMER ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80018-1765
Practice Address - Country:US
Practice Address - Phone:720-261-9932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist