Provider Demographics
NPI:1215376934
Name:DIAZ, YANET (DMD)
Entity Type:Individual
Prefix:DR
First Name:YANET
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3411
Mailing Address - Country:US
Mailing Address - Phone:786-262-5144
Mailing Address - Fax:
Practice Address - Street 1:8501 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3411
Practice Address - Country:US
Practice Address - Phone:786-262-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist