Provider Demographics
NPI:1285127084
Name:DELOSA, DANA NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:NICOLE
Last Name:DELOSA
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 1:8196 VIA DI VENETO
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1974
Mailing Address - Country:US
Mailing Address - Phone:954-304-3883
Mailing Address - Fax:
Practice Address - Street 1:11119 HEARTH RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-3727
Practice Address - Country:US
Practice Address - Phone:352-683-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist