Provider Demographics
NPI:1003929480
Name:DIEHL, JOAN PEYTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:PEYTON
Last Name:DIEHL
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:PO BOX 23176
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0274
Mailing Address - Country:US
Mailing Address - Phone:704-545-8831
Mailing Address - Fax:704-545-2354
Practice Address - Street 1:11235 LAWYERS ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-545-8831
Practice Address - Fax:704-545-2354
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006122300000X
AL3667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist