Provider Demographics
NPI:1023039856
Name:DIAMOND, LARRY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 FLORISTA ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2474
Mailing Address - Country:US
Mailing Address - Phone:562-430-1013
Mailing Address - Fax:562-799-7042
Practice Address - Street 1:3551 FLORISTA ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2474
Practice Address - Country:US
Practice Address - Phone:562-430-1013
Practice Address - Fax:562-799-7042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0366511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0485919OtherTAX ID