Lewis Michael Deldebbio
Individual provider Active NPI Dentist · Oakdale, CA
NPI 1043434426 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043434426
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 30903 (CA)
- Practice address
- 190 S Oak Ave
Building 1 Suite 1
Oakdale, CA 95361-3528 - Phone
- (209) 847-1320
- Fax
- (209) 847-4256
- NPI assigned
- Apr 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30903 | CA | Yes |
Addresses
Primary practice location
190 S Oak Ave
Building 1 Suite 1
Oakdale, CA 95361-3528
Mailing address
190 South Oak Ave
Building 1 Suite 1
Oakdale, CA 95361
Phone (209) 847-1320
Other providers in Oakdale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.