Provider Demographics
NPI:1619359585
Name:DIAZ, SABRINA (DMD)
Entity Type:Individual
Prefix:
First Name:SABRINA
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 1:1230 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4942
Mailing Address - Country:US
Mailing Address - Phone:352-376-5661
Mailing Address - Fax:352-376-8281
Practice Address - Street 1:1230 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4942
Practice Address - Country:US
Practice Address - Phone:352-376-5661
Practice Address - Fax:352-376-8281
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist