Provider Demographics
NPI:1245588656
Name:ABOYTES, DIANA BURNHAM (RDH)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:BURNHAM
Last Name:ABOYTES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARIE
Other - Last Name:BURNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:MSC09-5020
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-3641
Mailing Address - Fax:505-272-5584
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:MSC09-5020
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3641
Practice Address - Fax:505-272-5584
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2439124Q00000X
CA20684124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist