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General NPI Number Information
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NPI Number | 1487542403
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Entity Type | Individual
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Provider Name | DYONTAY M DIAL
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Gender | Male
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 3600 N 24TH ST # NE68110
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City | OMAHA
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State | NE
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Zip | 68110-1872
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Country | US
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Telephone | 330-394-4139
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 N 47TH ST
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City | OMAHA
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State | NE
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Zip | 68104-1403
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Country | US
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Telephone | 402-676-8311
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | ST.0004352
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License Number State | CO
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