MEDICARE: DR. DAWN ELLA DIEHNELT 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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1891841078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN ELLA DIEHNELT DDS

Provider Business Mailing Address
First Line	:	1328 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3401
Country	:	US
Telephone Number	:	847-818-0700
Fax Number	:	847-818-0705

Provider Business Practice Location Address
First Line	:	1328 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3401
Country	:	US
Telephone Number	:	847-818-0700
Fax Number	:	847-818-0705

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

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	07/08/2007

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