Provider Demographics
NPI:1417082611
Name:MUNSON, DIANE LAURA (RDH)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LAURA
Last Name:MUNSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 N SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3222
Mailing Address - Country:US
Mailing Address - Phone:516-795-1027
Mailing Address - Fax:
Practice Address - Street 1:1228 WANTAGH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2209
Practice Address - Country:US
Practice Address - Phone:516-679-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022088124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist