Provider Demographics
NPI:1831318443
Name:DIEHL, DAVID LEROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEROY
Last Name:DIEHL
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 1:4640 CROW CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6925
Mailing Address - Country:US
Mailing Address - Phone:563-332-8625
Mailing Address - Fax:
Practice Address - Street 1:3532 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2223
Practice Address - Country:US
Practice Address - Phone:563-359-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA53011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics