Provider Demographics
NPI:1194954164
Name:DELIMA, KATHRINA DEMECILLO (DMD)
Entity type:Individual
Prefix:
First Name:KATHRINA
Middle Name:DEMECILLO
Last Name:DELIMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 49TH ST APT FF6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2947
Mailing Address - Country:US
Mailing Address - Phone:678-360-6808
Mailing Address - Fax:
Practice Address - Street 1:4802 TENTH AVENUE
Practice Address - Street 2:MAIMONIDES MEDICAL CENTER, DEPARTMENT OF DENTISTRY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-283-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN01397311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program