Basic Information
| Provider Information | |||||||||
| NPI: | 1275718926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIYANAT | ||||||||
| FirstName: | NURULLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 TREMONT ST | ||||||||
| Address2: | |||||||||
| City: | ROXBURY CROSSING | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021202178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179893240 | ||||||||
| FaxNumber: | 6179893247 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 TREMONT ST | ||||||||
| Address2: | |||||||||
| City: | ROXBURY CROSSING | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021202178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179893240 | ||||||||
| FaxNumber: | 6179893247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2007 | ||||||||
| LastUpdateDate: | 12/31/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 9556 | MA | Y | Dental Providers | Dentist |
No ID Information.