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General NPI Number Information
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NPI Number | 1285133058
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Entity Type | Organization
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Legal Business Name | LARRY J. DIAMOND, D.D.S.
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 02/07/2018
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Provider Practice Location Address
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Address Line | 3551 FLORISTA ST STE 2A
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2490
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Country | US
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Telephone | 562-430-1013
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Fax | 562-799-7042
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Provider Business Mailing Address
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Address Line | 3551 FLORISTA ST STE 2A
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-2490
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Country | US
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Telephone | 562-430-1013
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Fax | 562-799-7042
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARRY J. DIAMOND
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Credential | DDS
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Telephone | 562-430-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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