Provider Demographics
NPI:1699921874
Name:DIEFES, DARRYL JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:JAMES
Last Name:DIEFES
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 1:904 SPIVEY RD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2915
Mailing Address - Country:US
Mailing Address - Phone:910-642-6500
Mailing Address - Fax:910-642-7581
Practice Address - Street 1:904 SPIVEY RD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2915
Practice Address - Country:US
Practice Address - Phone:910-642-6500
Practice Address - Fax:910-642-7581
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992153Medicaid