Provider Demographics
NPI:1275148744
Name:DIAMOND, ZACHARY RICHARD (DMD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:RICHARD
Last Name:DIAMOND
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 1:745 E BETTERAVIA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7024
Mailing Address - Country:US
Mailing Address - Phone:805-623-4228
Mailing Address - Fax:
Practice Address - Street 1:745 E BETTERAVIA RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7024
Practice Address - Country:US
Practice Address - Phone:805-623-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204527122300000X
CA108234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist