Provider Demographics
NPI:1437623154
Name:NONA DIAMOND DENTAL LLC
Entity type:Organization
Organization Name:NONA DIAMOND DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-791-6494
Mailing Address - Street 1:1696 S MILITARY TRL UNIT B
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5612
Mailing Address - Country:US
Mailing Address - Phone:561-791-6494
Mailing Address - Fax:
Practice Address - Street 1:1696 S MILITARY TRL UNIT B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-5612
Practice Address - Country:US
Practice Address - Phone:561-791-6494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013781100Medicaid