Provider Demographics
NPI:1902008220
Name:DIAMOND DENTAL, P.C.
Entity Type:Organization
Organization Name:DIAMOND DENTAL, P.C.
Other - Org Name:DIAMOND DENTAL SCARSDALE
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:914-472-9001
Mailing Address - Street 1:800 CENTRAL PARK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2589
Mailing Address - Country:US
Mailing Address - Phone:914-472-9001
Mailing Address - Fax:
Practice Address - Street 1:10 DUNWOODIE ST
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5411
Practice Address - Country:US
Practice Address - Phone:914-472-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY482131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty