Provider Demographics
NPI:1639275258
Name:DIAZ, RAUL E (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:E
Last Name:DIAZ
Suffix:
Gender:M
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-0186
Mailing Address - Country:US
Mailing Address - Phone:787-839-2333
Mailing Address - Fax:787-839-2333
Practice Address - Street 1:198 MORSE ST
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-0186
Practice Address - Country:US
Practice Address - Phone:787-839-2333
Practice Address - Fax:787-839-2333
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist