Provider Demographics
NPI:1689823791
Name:DIAMOND DENTAL, P.C.
Entity Type:Organization
Organization Name:DIAMOND DENTAL, P.C.
Other - Org Name:DIAMOND DENTAL MANHATTAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KUANGHAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-682-1488
Mailing Address - Street 1:161 MADISON AVE RM 7NW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5449
Mailing Address - Country:US
Mailing Address - Phone:212-682-1488
Mailing Address - Fax:
Practice Address - Street 1:420 LEXINGTON AVE RM 228
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0299
Practice Address - Country:US
Practice Address - Phone:212-682-1488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty