Provider Demographics
NPI:1346399417
Name:DIANA XA D.D.S., INC.
Entity Type:Organization
Organization Name:DIANA XA D.D.S., INC.
Other - Org Name:GOLDEN SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA TU-DIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:XA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-847-7800
Mailing Address - Street 1:7154 EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3505
Mailing Address - Country:US
Mailing Address - Phone:714-847-7800
Mailing Address - Fax:714-847-4010
Practice Address - Street 1:7154 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3505
Practice Address - Country:US
Practice Address - Phone:714-847-7800
Practice Address - Fax:714-847-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38944Medicaid