Provider Demographics
NPI:1174193643
Name:DIEP, HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:DIEP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 REGATTA CT
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-2708
Mailing Address - Country:US
Mailing Address - Phone:510-363-2658
Mailing Address - Fax:
Practice Address - Street 1:2844 SUMMIT ST STE 206
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3642
Practice Address - Country:US
Practice Address - Phone:510-319-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1061721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice