Provider Demographics
NPI:1114926706
Name:DELIE, ROBERT A (DMD, MDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:DELIE
Suffix:
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 HOLICONG ROAD
Mailing Address - Street 2:PO BOX 582
Mailing Address - City:BUCKINGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18912
Mailing Address - Country:US
Mailing Address - Phone:412-760-8070
Mailing Address - Fax:
Practice Address - Street 1:2547 HOLICONG ROAD
Practice Address - Street 2:582
Practice Address - City:BUCKINGHAM
Practice Address - State:PA
Practice Address - Zip Code:18912
Practice Address - Country:US
Practice Address - Phone:412-760-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 029581-L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics