Provider Demographics
NPI:1790757649
Name:MCGUIRE, DIEDRA S (DDS)
Entity type:Individual
Prefix:DR
First Name:DIEDRA
Middle Name:S
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 PRAIRIE ASTER CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6169
Mailing Address - Country:US
Mailing Address - Phone:914-419-3298
Mailing Address - Fax:
Practice Address - Street 1:1001 WIDEWATERS PKWY
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6102
Practice Address - Country:US
Practice Address - Phone:919-266-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-05
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics