Provider Demographics
NPI:1689329740
Name:DIAGDENTAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DIAGDENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-370-0739
Mailing Address - Street 1:523 E SAN YSIDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3110
Mailing Address - Country:US
Mailing Address - Phone:949-370-0739
Mailing Address - Fax:
Practice Address - Street 1:523 E SAN YSIDRO BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92173-3110
Practice Address - Country:US
Practice Address - Phone:858-263-6494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty