Provider Demographics
NPI:1679629380
Name:DESIREE S. DIMOND DDS,PC
Entity Type:Organization
Organization Name:DESIREE S. DIMOND DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-856-5268
Mailing Address - Street 1:3606 OLENDER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-2749
Mailing Address - Country:US
Mailing Address - Phone:317-856-5268
Mailing Address - Fax:317-856-8035
Practice Address - Street 1:3606 OLENDER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-2749
Practice Address - Country:US
Practice Address - Phone:317-856-5268
Practice Address - Fax:317-856-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty