Healthcare Provider Details

I. General information

NPI: 1316871627
Provider Name (Legal Business Name): DIANA SULEMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 CHRISTY DR
JEFFERSON CITY MO
65101-2854
US

IV. Provider business mailing address

5702 NW 19TH ST
LAUDERHILL FL
33313-4005
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-2777
  • Fax:
Mailing address:
  • Phone: 954-245-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026025301
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: