Provider Demographics
NPI:1639370737
Name:DAVID M. DIAZ, DDS
Entity Type:Organization
Organization Name:DAVID M. DIAZ, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BATTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-548-5588
Mailing Address - Street 1:1801 NEWPORT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2701
Mailing Address - Country:US
Mailing Address - Phone:949-548-5588
Mailing Address - Fax:949-548-5731
Practice Address - Street 1:1801 NEWPORT BLVD STE B
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2701
Practice Address - Country:US
Practice Address - Phone:949-548-5588
Practice Address - Fax:949-548-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherSOCIAL SECURITY NUMBER