Provider Demographics
NPI:1518289529
Name:DIAMOND, WILLIAM JOSHUA (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSHUA
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 1:1640 NICHOLASVILLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1493
Mailing Address - Country:US
Mailing Address - Phone:859-278-0085
Mailing Address - Fax:
Practice Address - Street 1:1640 NICHOLASVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1493
Practice Address - Country:US
Practice Address - Phone:859-278-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8832122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100228270Medicaid