Provider Demographics
NPI:1538364153
Name:THOMAS C. DELANEY DMD PC
Entity type:Organization
Organization Name:THOMAS C. DELANEY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-327-5188
Mailing Address - Street 1:1126 W PEARCE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1053
Mailing Address - Country:US
Mailing Address - Phone:636-327-5188
Mailing Address - Fax:636-332-9223
Practice Address - Street 1:1126 W PEARCE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1053
Practice Address - Country:US
Practice Address - Phone:636-327-5188
Practice Address - Fax:636-332-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty