Provider Demographics
NPI:1659739456
Name:DAVID DIEU DMD, MD, PA
Entity Type:Organization
Organization Name:DAVID DIEU DMD, MD, PA
Other - Org Name:PREMIER ORAL AND FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HAN
Authorized Official - Last Name:DIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:302-273-8300
Mailing Address - Street 1:1202 FOULK ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-273-8300
Mailing Address - Fax:
Practice Address - Street 1:1202 FOULK ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-273-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00013241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102705221000Medicaid
PA318452ZCDLMedicare UPIN