Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3667 | AL |
Y | 122300000X | Dentist | 5006 | NC |
NPI | 1003929480 |
---|---|
Provider Name | Dr. Joan Peyton Diehl |
First Address | Charlotte, NC 28227-0274 |
Second Address | Charlotte, NC 28227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |