Provider Demographics
NPI:1144337031
Name:MEYER, DIANE (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MEYER-KROTIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:331 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2620
Mailing Address - Country:US
Mailing Address - Phone:630-968-5567
Mailing Address - Fax:630-810-9943
Practice Address - Street 1:331 W 63RD ST
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2620
Practice Address - Country:US
Practice Address - Phone:630-968-5567
Practice Address - Fax:630-810-9943
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist