Individual
ATHENA DIAMANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
300 WEST AVE, BROCKPORT, NY 14420-1118
(585) 637-3905
(585) 637-4990
Mailing address
300 WEST AVE, BROCKPORT, NY 14420-1118
(585) 637-3905
(585) 637-4990
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
000077-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161020913
EMPLOYER TAX ID
NY
Enumeration date
11/13/2008
Last updated
11/13/2008
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