Provider Demographics
NPI:1306959655
Name:JOAN P. DIEHL, DMD, PA
Entity type:Organization
Organization Name:JOAN P. DIEHL, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:PEYTON
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-545-8831
Mailing Address - Street 1:PO BOX 23176
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0274
Mailing Address - Country:US
Mailing Address - Phone:704-545-8831
Mailing Address - Fax:704-545-2354
Practice Address - Street 1:11235 LAWYERS ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-545-8831
Practice Address - Fax:704-545-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3667122300000X
NC5006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty