Provider Demographics
NPI:1043392111
Name:DIEZ, FEDERICO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:
Last Name:DIEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4581 WESTON RD # 321
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3141
Mailing Address - Country:US
Mailing Address - Phone:305-725-3426
Mailing Address - Fax:954-517-1592
Practice Address - Street 1:12600 PEMBROKE RD
Practice Address - Street 2:SUITE 314
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-505-7631
Practice Address - Fax:954-505-7633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL142841223P0700X
FLDN 142841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice