Provider Demographics
NPI:1346453305
Name:DIAMOND, DAVID Z (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:Z
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 1:87 COMMUNITY RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7832
Mailing Address - Country:US
Mailing Address - Phone:631-665-3966
Mailing Address - Fax:631-665-4123
Practice Address - Street 1:87 COMMUNITY RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7832
Practice Address - Country:US
Practice Address - Phone:631-665-3966
Practice Address - Fax:631-665-4123
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0398191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice