Provider Demographics
NPI:1881115772
Name:DIABY, DARIA CLEGG (DMD)
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:CLEGG
Last Name:DIABY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DARIA
Other - Middle Name:PARICE
Other - Last Name:CLEGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 BLOOMOVER ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9055
Mailing Address - Country:US
Mailing Address - Phone:704-615-9922
Mailing Address - Fax:
Practice Address - Street 1:10018 BENFIELD RD STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8819
Practice Address - Country:US
Practice Address - Phone:704-228-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10704122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist