Provider Demographics
NPI:1427073204
Name:POOLER, DIANE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:POOLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SAN PEDRO RD
Mailing Address - Street 2:STE.#B
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2502
Mailing Address - Country:US
Mailing Address - Phone:650-756-6968
Mailing Address - Fax:
Practice Address - Street 1:66 SAN PEDRO RD
Practice Address - Street 2:STE.#B
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2502
Practice Address - Country:US
Practice Address - Phone:650-756-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35647122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist