Provider Demographics
NPI:1447729645
Name:DENTAL DIAMOND LLC
Entity type:Organization
Organization Name:DENTAL DIAMOND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-656-8266
Mailing Address - Street 1:1 WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-1760
Mailing Address - Country:US
Mailing Address - Phone:302-656-8266
Mailing Address - Fax:302-656-4661
Practice Address - Street 1:1 WINSTON AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1760
Practice Address - Country:US
Practice Address - Phone:302-656-8266
Practice Address - Fax:302-656-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental