Provider Demographics
NPI:1699887364
Name:DIEHL, AARON P (DDS)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:P
Last Name:DIEHL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N CLYBOURN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-9353
Mailing Address - Country:US
Mailing Address - Phone:773-340-2016
Mailing Address - Fax:
Practice Address - Street 1:1750 N CLYBOURN AVE
Practice Address - Street 2:STE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-9353
Practice Address - Country:US
Practice Address - Phone:773-340-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528351122300000X
IL019027807122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist