Provider Demographics
NPI:1396262317
Name:YOUSEF, DIANE (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:YOUSEF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-4657
Mailing Address - Country:US
Mailing Address - Phone:201-845-9334
Mailing Address - Fax:
Practice Address - Street 1:505 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-4657
Practice Address - Country:US
Practice Address - Phone:201-845-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0428581223G0001X
NJDI02688800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice