Provider Demographics
NPI:1205185410
Name:OSMANI DIAZ DDS PA
Entity Type:Organization
Organization Name:OSMANI DIAZ DDS PA
Other - Org Name:DIAZ RESTORATIVE DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-437-9288
Mailing Address - Street 1:650 NW 180TH TER STE 103
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2825
Mailing Address - Country:US
Mailing Address - Phone:954-437-9288
Mailing Address - Fax:954-437-7929
Practice Address - Street 1:650 NW 180TH TER STE 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2825
Practice Address - Country:US
Practice Address - Phone:954-437-9288
Practice Address - Fax:954-437-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN123101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty