Provider Demographics
NPI:1124041355
Name:DIAZ, MANUEL ENRIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ENRIQUE
Last Name:DIAZ
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 1:1400 EL CAMINO VILLAGE DR
Mailing Address - Street 2:APT. # 2707
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3066
Mailing Address - Country:US
Mailing Address - Phone:713-202-3203
Mailing Address - Fax:
Practice Address - Street 1:12600 N FEATHERWOOD DR
Practice Address - Street 2:SUITE 220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4443
Practice Address - Country:US
Practice Address - Phone:281-484-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery