Provider Demographics
NPI:1932247731
Name:DIANA, JOHN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:DIANA
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BUILDING 11, SUITE C
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2555
Mailing Address - Country:US
Mailing Address - Phone:631-751-8004
Mailing Address - Fax:631-751-2510
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:BUILDING 11, SUITE C
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-751-8004
Practice Address - Fax:631-751-2510
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0372081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics