Provider Demographics
NPI:1912999509
Name:DELMOE, ERNEST FRANKLIN (DDS)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:FRANKLIN
Last Name:DELMOE
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 1:13760 N 93RD AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4250
Mailing Address - Country:US
Mailing Address - Phone:623-933-6010
Mailing Address - Fax:623-933-6523
Practice Address - Street 1:13760 N 93RD AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4250
Practice Address - Country:US
Practice Address - Phone:623-933-6010
Practice Address - Fax:623-933-6523
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD45091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ188822Medicaid