MEDICARE: DR. DAVID LEROY DIEHL D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	5301	IA

General Provider Information

NPI Number	:	1831318443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID LEROY DIEHL D.D.S.

Provider Business Mailing Address
First Line	:	4640 CROW CREEK CT
Second Line	:
City	:	BETTENDORF
State	:	IA
Zip	:	52722-6925
Country	:	US
Telephone Number	:	563-332-8625
Fax Number	:

Provider Business Practice Location Address
First Line	:	3532 JERSEY RIDGE RD
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2223
Country	:	US
Telephone Number	:	563-359-8273
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. DAVID LEROY DIEHL D.D.S.” Practice Location

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