Provider Demographics
NPI:1790985075
Name:DIAMOND, ARLEN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARLEN
Middle Name:ROBERT
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 VAN NUYS BLVD
Mailing Address - Street 2:SUITE #210
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1715
Mailing Address - Country:US
Mailing Address - Phone:818-995-1072
Mailing Address - Fax:818-995-1171
Practice Address - Street 1:4910 VAN NUYS BLVD
Practice Address - Street 2:SUITE #210
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1715
Practice Address - Country:US
Practice Address - Phone:818-995-1072
Practice Address - Fax:818-995-1171
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist