Provider Demographics
NPI:1184712309
Name:DIAMOND, OLWYN (DDS)
Entity type:Individual
Prefix:DR
First Name:OLWYN
Middle Name:
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 1:6666 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4013
Mailing Address - Country:US
Mailing Address - Phone:410-944-6666
Mailing Address - Fax:410-944-1046
Practice Address - Street 1:2835 SMITH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1453
Practice Address - Country:US
Practice Address - Phone:410-486-3636
Practice Address - Fax:410-486-3657
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD78701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics