Provider Demographics
NPI:1639451495
Name:DIEHL, KATHLEEN J (DMD)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:J
Last Name:DIEHL
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:J
Other - Last Name:LOMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 W OAK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240
Mailing Address - Country:US
Mailing Address - Phone:209-334-0938
Mailing Address - Fax:209-334-4432
Practice Address - Street 1:207 W OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240
Practice Address - Country:US
Practice Address - Phone:209-334-0938
Practice Address - Fax:209-334-4432
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice