Provider Demographics
NPI:1538963251
Name:WILL O. DELIZ DMD, INC
Entity type:Organization
Organization Name:WILL O. DELIZ DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELIZ
Authorized Official - Middle Name:DENTAL STUDIO
Authorized Official - Last Name:DELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-755-1800
Mailing Address - Street 1:2448 BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6403
Mailing Address - Country:US
Mailing Address - Phone:813-755-1800
Mailing Address - Fax:813-755-1801
Practice Address - Street 1:2448 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6403
Practice Address - Country:US
Practice Address - Phone:813-755-1800
Practice Address - Fax:813-755-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental