Individual
BRENDAN JAMES DELINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
145 DON PASQUAL RD NW, LOS LUNAS, NM 87031-8841
(505) 224-8740
Mailing address
145 DON PASQUAL RD NW, LOS LUNAS, NM 87031-8841
(505) 224-8740
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD5636
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
04/13/2021
Last updated
10/06/2022
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