Provider Demographics
NPI:1740920115
Name:DIAMENT, DAVID ALTER (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALTER
Last Name:DIAMENT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 WALRAVEN DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5121
Mailing Address - Country:US
Mailing Address - Phone:732-853-4009
Mailing Address - Fax:
Practice Address - Street 1:809 STATE ROUTE 208
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1829
Practice Address - Country:US
Practice Address - Phone:845-782-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0635031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program