Provider Demographics
NPI:1639175623
Name:DIAZ, OSMANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:OSMANI
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NW 180TH TER
Mailing Address - Street 2:STE 103
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2825
Mailing Address - Country:US
Mailing Address - Phone:954-437-9288
Mailing Address - Fax:954-437-7929
Practice Address - Street 1:650 NW 180TH TER
Practice Address - Street 2:STE 103
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2825
Practice Address - Country:US
Practice Address - Phone:954-437-9288
Practice Address - Fax:954-437-7929
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN123101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice