Healthcare Provider Details

I. General information

NPI: 1144774613
Provider Name (Legal Business Name): JOSEPH LOCHINVAR DINGLASAN SR MD SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 BOWCREEK DR
DIAMOND BAR CA
91765-1885
US

IV. Provider business mailing address

11800 NORTHFALL LN SUITE 1405
ALPHARETTA GA
30009-7976
US

V. Phone/Fax

Practice location:
  • Phone: 770-895-8483
  • Fax:
Mailing address:
  • Phone: 404-748-5249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number018799
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: