Provider Demographics
NPI:1407983208
Name:DIAMONON, CARLOS BERCES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:BERCES
Last Name:DIAMONON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 40TH ST RM 705
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1213
Mailing Address - Country:US
Mailing Address - Phone:917-796-1910
Mailing Address - Fax:
Practice Address - Street 1:30 E 40TH ST
Practice Address - Street 2:SUITE 705
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1201
Practice Address - Country:US
Practice Address - Phone:212-679-2591
Practice Address - Fax:212-397-3382
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist