Provider Demographics
NPI:1487542403
Name:DIAL, DYONTAY M
Entity type:Individual
Prefix:
First Name:DYONTAY
Middle Name:M
Last Name:DIAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1403
Mailing Address - Country:US
Mailing Address - Phone:402-676-8311
Mailing Address - Fax:
Practice Address - Street 1:3600 N 24TH ST # NE68110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-1872
Practice Address - Country:US
Practice Address - Phone:330-394-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COST.0004352207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine