Provider Demographics
NPI:1285774091
Name:DIAMOND, VICTOR D (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:D
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ATTUCKS LN
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1809
Mailing Address - Country:US
Mailing Address - Phone:508-771-4555
Mailing Address - Fax:507-771-6656
Practice Address - Street 1:700 ATTUCKS LN
Practice Address - Street 2:SUITE 2B
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1809
Practice Address - Country:US
Practice Address - Phone:508-771-4555
Practice Address - Fax:508-771-6656
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1174675367OtherORGANIZATION NIP