Provider Demographics
NPI:1518280346
Name:DIAZ AND GILES PA
Entity Type:Organization
Organization Name:DIAZ AND GILES PA
Other - Org Name:MARKETPLACE DENTAL GROUP AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-441-4455
Mailing Address - Street 1:402 SIMONTON STREET
Mailing Address - Street 2:SUITE # 100
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301
Mailing Address - Country:US
Mailing Address - Phone:936-441-4455
Mailing Address - Fax:
Practice Address - Street 1:402 SIMONTON ST
Practice Address - Street 2:SUITE # 100
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2666
Practice Address - Country:US
Practice Address - Phone:936-441-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty