Provider Demographics
NPI:1366857989
Name:INFINITY DENTAL ARTS
Entity Type:Organization
Organization Name:INFINITY DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-218-2132
Mailing Address - Street 1:6611 OLD MONROE ROAD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5352
Mailing Address - Country:US
Mailing Address - Phone:704-218-2132
Mailing Address - Fax:888-977-1574
Practice Address - Street 1:6611 OLD MONROE ROAD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5352
Practice Address - Country:US
Practice Address - Phone:704-218-2132
Practice Address - Fax:888-977-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90351223G0001X
NC89141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty