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NPI Code Detail

MEDICARE: DR. CHARLES KEITH DIDDY DDS

MEDICARE:  DR. CHARLES KEITH DIDDY  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist20174CA

General Provider Information

NPI Number : 1922570134
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES KEITH DIDDY DDS
Provider Business Mailing Address
First Line : 5637 N PALM AVE APT B
Second Line :
City : FRESNO
State : CA
Zip : 93704-1829
Country : US
Telephone Number : 559-246-0469
Fax Number :
Provider Business Practice Location Address
First Line : 5637 N PALM AVE APT B
Second Line :
City : FRESNO
State : CA
Zip : 93704-1829
Country : US
Telephone Number : 559-246-0469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2018
Last Update Date : 12/28/2018

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Directions to “ DR. CHARLES KEITH DIDDY DDS” Practice Location

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