Provider Demographics
NPI:1386846459
Name:DIAZ PASTRANA DENTAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DIAZ PASTRANA DENTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-601-9404
Mailing Address - Street 1:26 E MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2451
Mailing Address - Country:US
Mailing Address - Phone:609-601-9404
Mailing Address - Fax:609-601-9406
Practice Address - Street 1:26 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2451
Practice Address - Country:US
Practice Address - Phone:609-601-9404
Practice Address - Fax:609-601-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0188241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty