Provider Demographics
NPI:1528061421
Name:DELSNYDER, JON M (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:M
Last Name:DELSNYDER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 S RURAL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3793
Mailing Address - Country:US
Mailing Address - Phone:602-346-9775
Mailing Address - Fax:
Practice Address - Street 1:6655 S RURAL RD STE 1
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3793
Practice Address - Country:US
Practice Address - Phone:602-346-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD71141223X2210X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty