Provider Demographics
NPI:1336332493
Name:DEACON, DIANE GAFFNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:GAFFNEY
Last Name:DEACON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:LYNN
Other - Last Name:GAFFNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:505 KERR AVENUE
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629
Mailing Address - Country:US
Mailing Address - Phone:410-479-0300
Mailing Address - Fax:
Practice Address - Street 1:505 KERR AVENUE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629
Practice Address - Country:US
Practice Address - Phone:410-479-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist