Provider Demographics
NPI:1730240847
Name:POWERS, DIANA CROOKS (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CROOKS
Last Name:POWERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BOVET RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3138
Mailing Address - Country:US
Mailing Address - Phone:650-342-1663
Mailing Address - Fax:
Practice Address - Street 1:160 BOVET RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3138
Practice Address - Country:US
Practice Address - Phone:650-342-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice