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General NPI Number Information
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NPI Number | 1417043332
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Entity Type | Individual
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Provider Name | MARY L. DIMYAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 42 PASEO DE CASTANA
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-6385
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Country | US
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Telephone | 310-427-4987
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Fax |
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Provider Business Mailing Address
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Address Line | 42 PASEO DE CASTANA
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-6385
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Country | US
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Telephone | 310-427-4987
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Fax | 310-544-7344
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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 | 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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44163
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License Number State | CA
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