Provider Demographics
NPI:1346467024
Name:DIAZ, MARIA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
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:ME8 AVE LA MARINA
Mailing Address - Street 2:MARINA BAHIA
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962
Mailing Address - Country:US
Mailing Address - Phone:787-790-1781
Mailing Address - Fax:787-790-2063
Practice Address - Street 1:SUPER CENTRO LA MUDA CARR. 20 KM.9.2
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-790-1781
Practice Address - Fax:787-790-2063
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2568122300000X
OH30.024571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist