Healthcare Provider Details

I. General information

NPI: 1588606552
Provider Name (Legal Business Name): DEKARLOS M DIAL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 WESTCHESTER DR STE 300
HIGH POINT NC
27262-7369
US

IV. Provider business mailing address

1701 WESTCHESTER DR STE 850
HIGH POINT NC
27262-7254
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2055
  • Fax: 336-802-2056
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005699
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: