Provider Demographics
NPI:1417043332
Name:DIMYAN, MARY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:DIMYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PASEO DE CASTANA
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6385
Mailing Address - Country:US
Mailing Address - Phone:310-427-4987
Mailing Address - Fax:310-544-7344
Practice Address - Street 1:42 PASEO DE CASTANA
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6385
Practice Address - Country:US
Practice Address - Phone:310-427-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44163122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist