Provider Demographics
NPI:1124294178
Name:DEPAUL, DIANE MARIE
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:DEPAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5564 WILSON MILLS RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3265
Mailing Address - Country:US
Mailing Address - Phone:440-461-9600
Mailing Address - Fax:440-461-4035
Practice Address - Street 1:5564 WILSON MILLS RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3265
Practice Address - Country:US
Practice Address - Phone:440-461-9600
Practice Address - Fax:440-461-4035
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00118496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist