Provider Demographics
NPI:1073103081
Name:WHITE, DIAMOND (DA)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BILLINGS ST APT 210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-4020
Mailing Address - Country:US
Mailing Address - Phone:720-609-0604
Mailing Address - Fax:
Practice Address - Street 1:13605 EAST 17TH AVENUE
Practice Address - Street 2:MAIL STOP F850
Practice Address - City:AUAROA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-724-6900
Practice Address - Fax:303-724-6938
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002146126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant