Provider Demographics
NPI:1992288666
Name:DELGADO, ALYSSA LYNN (RDH)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNN
Last Name:DELGADO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 HOPE ST APT 120
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6799
Mailing Address - Country:US
Mailing Address - Phone:505-328-5749
Mailing Address - Fax:
Practice Address - Street 1:150 SOUTH ROAD
Practice Address - Street 2:CSB 334
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:505-328-5749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH10384124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist