Provider Demographics
NPI:1275636177
Name:FENG, DIANE (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:FENG
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3647
Mailing Address - Country:US
Mailing Address - Phone:215-742-7139
Mailing Address - Fax:215-742-7139
Practice Address - Street 1:1133 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3647
Practice Address - Country:US
Practice Address - Phone:215-742-7139
Practice Address - Fax:215-742-7139
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029122-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice