Active NPI
Nicholas Delisle, DMD
- Pediatric Dentistry
- Kailua-Kona, HI
National Provider Identifier
1073963385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 3084
- Practice address
- 74-5214 Kkeanalehu Dr
Kailua-Kona, HI 96740 - Phone
- (808) 353-5650
- NPI assigned
- Jun 17, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 3084 | HI | Primary |
Addresses
Primary practice location
74-5214 Kkeanalehu Dr
Kailua-Kona, HI 96740
Mailing address
4800 4TH Way SW
Olympia, WA 98502-2683
Phone (702) 624-5850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3084 | HI | MD | Pediatric Dentist |
Interoperability endpoints
- nicholas.delisle.p1@direct.wcchc.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1073963385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4800 4TH WAY SW",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985022683",
"telephone_number": "702-624-5850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "74-5214 KKEANALEHU DR",
"city": "KAILUA-KONA",
"state": "HI",
"postal_code": "96740",
"telephone_number": "808-353-5650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELISLE",
"first_name": "NICHOLAS",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-17",
"last_updated": "2023-08-17",
"certification_date": "2023-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "HI",
"license": "3084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kailua-Kona, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.