Provider Demographics
NPI:1124367818
Name:DIANA, KATE MARIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:MARIEL
Last Name:DIANA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1545
Mailing Address - Country:US
Mailing Address - Phone:201-446-0694
Mailing Address - Fax:
Practice Address - Street 1:336 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1717
Practice Address - Country:US
Practice Address - Phone:201-594-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025232001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice