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General NPI Number Information
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NPI Number | 1174193643
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Entity Type | Individual
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Provider Name | HENRY DIEP DMD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 2844 SUMMIT ST STE 206
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City | OAKLAND
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State | CA
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Zip | 94609-3642
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Country | US
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Telephone | 510-319-0189
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Fax |
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Provider Business Mailing Address
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Address Line | 2252 REGATTA CT
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City | SAN LEANDRO
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State | CA
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Zip | 94579-2708
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Country | US
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Telephone | 510-363-2658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 106172
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License Number State | CA
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