MEDICARE: DR. DIANA L OQUINN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	17184	TX
2	122300000X	Dentist	DN 10035	FL

General Provider Information

NPI Number	:	1205070372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA L OQUINN DDS

Provider Business Mailing Address
First Line	:	4909 W PARK BLVD
Second Line	:	#117
City	:	PLANO
State	:	TX
Zip	:	75093-2311
Country	:	US
Telephone Number	:	972-519-1990
Fax Number	:	972-964-0047

Provider Business Practice Location Address
First Line	:	4909 W PARK BLVD
Second Line	:	#117
City	:	PLANO
State	:	TX
Zip	:	75093-2311
Country	:	US
Telephone Number	:	972-519-1990
Fax Number	:	972-964-0047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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