Provider Demographics
NPI:1912081498
Name:DIAMOND, ANDREW B (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MAHOGANY WALK
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4211
Mailing Address - Country:US
Mailing Address - Phone:215-657-2211
Mailing Address - Fax:215-657-2213
Practice Address - Street 1:2300 COMPUTER RD
Practice Address - Street 2:B9-10
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1752
Practice Address - Country:US
Practice Address - Phone:215-657-2211
Practice Address - Fax:215-657-2213
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics