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General NPI Number Information
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NPI Number | 1881056612
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Entity Type | Individual
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Provider Name | PAUL DIAMOND D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 1835 E GUADALUPE RD STE C-107
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City | TEMPE
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State | AZ
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Zip | 85283-3277
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Country | US
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Telephone | 480-345-4017
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Fax |
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Provider Business Mailing Address
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Address Line | 5528 E ENROSE ST
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City | MESA
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State | AZ
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Zip | 85205-5455
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Country | US
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Telephone | 480-510-6158
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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 | D009445
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License Number State | AZ
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