Provider Demographics
NPI:1114000122
Name:MARY L. DIMYAN, DDS.INC
Entity Type:Organization
Organization Name:MARY L. DIMYAN, DDS.INC
Other - Org Name:ANGEL'S TOUCH DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-544-7044
Mailing Address - Street 1:43 PENINSULA CTR # B
Mailing Address - Street 2:SUITE #2
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3506
Mailing Address - Country:US
Mailing Address - Phone:310-544-7044
Mailing Address - Fax:310-544-7344
Practice Address - Street 1:43 PENINSULA CTR # B
Practice Address - Street 2:SUITE #2
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3506
Practice Address - Country:US
Practice Address - Phone:310-544-7044
Practice Address - Fax:310-544-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44163OtherDENTAL LICENSE