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General NPI Number Information
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NPI Number | 1114000122
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Entity Type | Organization
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Legal Business Name | MARY L. DIMYAN, DDS.INC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 43 PENINSULA CTR # B SUITE #2
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3506
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Country | US
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Telephone | 310-544-7044
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Fax | 310-544-7344
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Provider Business Mailing Address
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Address Line | 43 PENINSULA CTR # B SUITE #2
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3506
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Country | US
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Telephone | 310-544-7044
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Fax | 310-544-7344
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARY L DIMYAN
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Credential | D.D.S.
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Telephone | 310-544-7044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44163
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License Number State | CA
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