Provider Demographics
NPI:1336575646
Name:CLINE, DIANA MONTAGU (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MONTAGU
Last Name:CLINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 US HIGHWAY 1 S
Mailing Address - Street 2:SUITE B, ATTN: DIANA CLINE
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6100
Mailing Address - Country:US
Mailing Address - Phone:803-270-6665
Mailing Address - Fax:
Practice Address - Street 1:2510 US HIGHWAY 1 S
Practice Address - Street 2:SUITE B, ATTN: DIANA CLINE
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6100
Practice Address - Country:US
Practice Address - Phone:803-270-6665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN212861223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics