Provider Demographics
NPI:1679778195
Name:PETER DELLIOS DDS PC
Entity type:Organization
Organization Name:PETER DELLIOS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DELLIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-837-5227
Mailing Address - Street 1:16425 E PALISADES BOULEVARD
Mailing Address - Street 2:STE 106
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268
Mailing Address - Country:US
Mailing Address - Phone:480-837-5227
Mailing Address - Fax:
Practice Address - Street 1:16425 E PALISADES BLVD
Practice Address - Street 2:STE 106
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3754
Practice Address - Country:US
Practice Address - Phone:480-837-5227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty