Provider Demographics
NPI:1326441718
Name:DIANA CRAFT DDS INC.
Entity Type:Organization
Organization Name:DIANA CRAFT DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-218-0433
Mailing Address - Street 1:1161 PUERTA DEL SOL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6311
Mailing Address - Country:US
Mailing Address - Phone:949-218-0433
Mailing Address - Fax:
Practice Address - Street 1:1161 PUERTA DEL SOL
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6311
Practice Address - Country:US
Practice Address - Phone:949-218-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty