Provider Demographics
NPI:1659488096
Name:KYRKOS, DIANA A (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:A
Last Name:KYRKOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:A
Other - Last Name:DIMASSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:660 DOVER CENTER RD STE 122
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140
Mailing Address - Country:US
Mailing Address - Phone:440-892-5556
Mailing Address - Fax:440-899-0408
Practice Address - Street 1:660 DOVER CENTER RD STE 122
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140
Practice Address - Country:US
Practice Address - Phone:440-892-5556
Practice Address - Fax:440-899-0408
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry