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General NPI Number Information
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NPI Number | 1245968981
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Entity Type | Individual
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Provider Name | ALAN DIEP DMD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 528 W BALDWIN RD UNIT B
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City | PANAMA CITY
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State | FL
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Zip | 32405-3313
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Country | US
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Telephone | 850-215-0128
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MC DAVIS LOOP UNIT 3106
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-6787
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Country | US
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Telephone | 281-777-2856
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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 | 27317
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License Number State | FL
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