Provider Demographics
NPI:1598070716
Name:TONOUKOUIN, DIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:TONOUKOUIN
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 1:5364 VININGS LAKE VW SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2563
Mailing Address - Country:US
Mailing Address - Phone:202-468-9372
Mailing Address - Fax:
Practice Address - Street 1:1134 SENOIA RD
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-1622
Practice Address - Country:US
Practice Address - Phone:770-964-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14488122300000X
CT010331122300000X
GADN015104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008023033Medicaid