Provider Demographics
NPI:1881056612
Name:DIAMOND, PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:DIAMOND
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 1:5528 E ENROSE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5455
Mailing Address - Country:US
Mailing Address - Phone:480-510-6158
Mailing Address - Fax:
Practice Address - Street 1:1835 E GUADALUPE RD
Practice Address - Street 2:STE C-107
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3277
Practice Address - Country:US
Practice Address - Phone:480-345-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0094451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice