Provider Demographics
NPI:1447339262
Name:DELANCEY, ANTHONY LEE (DSS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LEE
Last Name:DELANCEY
Suffix:
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3413
Mailing Address - Country:US
Mailing Address - Phone:515-274-5151
Mailing Address - Fax:515-274-6259
Practice Address - Street 1:3830 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3413
Practice Address - Country:US
Practice Address - Phone:515-274-5151
Practice Address - Fax:515-274-6259
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice