Provider Demographics
NPI:1942900774
Name:DAHLIA THE DIETITIAN LLC
Entity Type:Organization
Organization Name:DAHLIA THE DIETITIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAHLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:828-482-5553
Mailing Address - Street 1:1101 HAWTHORNE LN APT 227
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2994
Mailing Address - Country:US
Mailing Address - Phone:828-482-5553
Mailing Address - Fax:
Practice Address - Street 1:1101 HAWTHORNE LN APT 227
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2994
Practice Address - Country:US
Practice Address - Phone:828-482-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty