Provider Demographics
NPI:1578185690
Name:STEVEN DIAK, DMD, PC
Entity Type:Organization
Organization Name:STEVEN DIAK, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEPPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-330-8114
Mailing Address - Street 1:1901 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1231
Mailing Address - Country:US
Mailing Address - Phone:610-373-3720
Mailing Address - Fax:
Practice Address - Street 1:1901 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1231
Practice Address - Country:US
Practice Address - Phone:610-373-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty