Provider Demographics
NPI:1114044807
Name:DIANA, KENNETH FRANK (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:FRANK
Last Name:DIANA
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 1:419 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5025
Mailing Address - Country:US
Mailing Address - Phone:732-477-1242
Mailing Address - Fax:
Practice Address - Street 1:419 NASSAU ST
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-5025
Practice Address - Country:US
Practice Address - Phone:732-477-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI126211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice