Provider Demographics
NPI:1093816431
Name:CONLY, DIANE C (DDS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:CONLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 MAGNOLIA AVE
Mailing Address - Street 2:#A
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2997
Mailing Address - Country:US
Mailing Address - Phone:562-695-1219
Mailing Address - Fax:
Practice Address - Street 1:5702 MAGNOLIA AVE
Practice Address - Street 2:#A
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-2997
Practice Address - Country:US
Practice Address - Phone:562-695-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice