Provider Demographics
NPI:1659041911
Name:DIANNE DENTAL PLLC
Entity Type:Organization
Organization Name:DIANNE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:GISELLE
Authorized Official - Last Name:GALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-865-0479
Mailing Address - Street 1:4115 POND HILL RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231
Mailing Address - Country:US
Mailing Address - Phone:210-865-0479
Mailing Address - Fax:210-686-2866
Practice Address - Street 1:4115 POND HILL RD UNIT 102
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231
Practice Address - Country:US
Practice Address - Phone:210-865-0479
Practice Address - Fax:210-686-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194333419OtherPPO