Provider Demographics
NPI:1174675367
Name:VICTOR D DIAMOND DMD PC
Entity Type:Organization
Organization Name:VICTOR D DIAMOND DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-771-4555
Mailing Address - Street 1:700 ATTUCKS LN
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1809
Mailing Address - Country:US
Mailing Address - Phone:508-771-4555
Mailing Address - Fax:508-771-6656
Practice Address - Street 1:700 ATTUCKS LN
Practice Address - Street 2:SUITE 2B
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1809
Practice Address - Country:US
Practice Address - Phone:508-771-4555
Practice Address - Fax:508-771-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty